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Predictive factors of serious vascular events in HIV patients in LATINA (LATInamerican Network on AIDS)
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Reported by Jules Levin
5th IAS Capetown July 19-22 2009
W.H. Belloso1, L.C. Orellana2, M.H. Losso3, B. Grinsztejn4, V.G. Veloso4, R. Ismerio Moreira4, J. Sierra Madero5, B. Crabtree5, A. La Rosa6, J. Peinado6, J. Sanchez6, O. Garcia Messina7
1CICAL / Hospital Italiano de Buenos Aires, Infectious Diseases, Buenos Aires, Argentina, 2CICAL / Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Instituto de Calculo, Buenos Aires, Argentina, 3CICAL / Hospital JM Ramos Mejia, Servicio de Inmunocomprometidos, Buenos Aires, Argentina, 4Instituto de Pesquisa Clinica Evandro Chagas-Fiocruz, Rio de Janeiro, Brazil, 5Instituto Nacional de Ciencias Medicas y Nutrición Salvador Zubirán, Mexico DF, Mexico, 6IMPACTA / INMENSA, Lima, Peru, 7CICAL / Hospital Piñero, Buenos Aires, Argentina
INTRODUCTION
In recent years, growing evidence has been reported concerning the association between the magnitude of immune suppression and occurrence of several serious non-AIDS (SNA) defining illnesses in the context of HIV-infection.
Serious vascular events (SVE) (Myocardial infarction, vardiovascular disease requiring invasive procedure, and stroke) have been found with increasing frequency in the context of the aging population of HIV-infected patients.
This increase appears to be driven both by a high prevalence of traditional risk factors and HIV-specific factors such as chronic inflammation, treatment-associated hyperlipidemias and immunodeficiency.
In most Latin-American countries, there is a prolonged history of provision of care and antiretroviral therapy (cART) for all patients in need.
We decided to analyze the frequency of SVEs and the variables associated with an increased risk of its appearance in a Latin-American population cohort of persons living with HIV (PLWH).
POPULATION
LATINA (LATInamerican Network on AIDS) is a multi-national initiative designed to provide systemic information on the epidemiological, clinical, and therapeutic response of PLWH within the Latin American region.
Each participating country established a Coordinating Center (CC) responsible for data collection from individual sites and national network expansion.
LATINA Retrospective cohort collected basic epidemiological and clinical data from patients followed at participating sites since January 1997 to present.
In the LATINA Retrospective cohort:
- 6007 patients were included with a mean followup of 3.2 person/years.
- 30% of patients were female
- 21.2% had a history of AIDS-defining condition
- incidence of AIDS 4.7 per 100 person/years during the followup
In the present study:
- 7 sites from 4 CCs completed their data collection
- 40 patients had a Serious Vascular Event (SVE)
METHODS - DESIGN summary and Analysis
The effect of each factor on the risk of a SVE was estimated through a conditional logistic regression. Results are presented as hazard ratio estimation and 95% confidence interval.
Different conditional logistic regression models were fitted including treatment related factors: immunological status and known risks factors for the vascular events. Best predictive model was selected.
16 Stroke; 11 Coronary Artery Disease; 13 Myocardial Infarction.
*Calculated under a conditional logistic regression model.
(*) Hazard ratios estimated under a conditional logistic regression model.
(*) harad ratios estimated under a conditional logistic regression model.
(*) Harad ratios estimated under a conditional logitic regression model.
(*) Odds ratios estimated under a conditional logistic regression model.
AUTHOR CONCLUSIONS
In this retrospective cohort of HIV patients from Latin American sites, the relative frequency of SVEs were similar to those described in series from other geographical areas.
Traditionally recognized risk factors such as diabetes were significantly related to the appearance of SVEs as seen in the general population.
In addition, HIV and treatment-associated variables showed an association with the occurrence of SVEs. History of AIDS and more severe immunodeficiency were found more often in patients with vascular events, after adjusting for other potential confounding factors.
Abacavir use in proximity to the index date was associated with an increased risk of vascular events, in a similar way as suggested in other cohorts.
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