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Cardiovascular Risk More Likely With Longer Viral Control in WIHS Women
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Conference on Retroviruses and Opportunistic Infections (CROI), February 13-16, 2017, Seattle
Mark Mascolini
Compared with women who often had a detectable HIV load, those with longer viral suppression were 40% more likely to report cardiovascular risk factors, according to a 2440-woman analysis of the Women's Interagency HIV Study (WIHS) [1]. But this excess cardiovascular risk did not translate into a higher rate of cardiovascular disease outcomes throughout this 1994-2015 analysis.
WIHS investigators aimed to examine the association between longitudinal HIV viral trajectories and HIV-related and unrelated comorbidities in cohort members. WIHS enrolled HIV-positive and negative women in 1994-1995, 2001-2002, 2011-2012, and 2013-2015. This analysis focused on 2440 HIV-positive women who made more than 4 twice-yearly visits to determine how long women kept their viral load below 80 copies. Among these women, 711 (29%) usually maintained an undetectable viral load (no-viremia group), 719 (29%) had intermittent viremia, and 1010 (41%) had generally sustained viremia.
Overall, 58% of study participants were black, including 50% in the no-viremia group, 57% in the intermittent-viremia group, and 65% in the sustained-viremia group (P < 0.0001). The no-viremia group was significantly older (average 37 years) than the intermittent-viremia group (average 36) and the sustained-viremia group (average 36) (P = 0.003). Cumulative years of viral suppression averaged 20 in the no-viremia group, 13 in the intermittent-viremia group, and 5 in the sustained-viremia group.
A significantly higher proportion in the no-viremia group (73%) than in the intermittent group (67%) or the sustained-viremia group (64%) had self-reported cardiovascular risk factors (P = 0.0007). But across those three groups, reports of cardiovascular disease were lowest in the no-viremia group (11.25% versus 15.16% versus 12.77%, P = 0.0855). Significantly fewer women in the no-viremia group died during follow-up (15%) than did women in the intermittent group (31%) or the sustained-viremia group (38%) (P < 0.0001).
A multivariate model adjusted for race, age, CD4 count, depression, illicit drug use, alcohol use, self-reported adherence, death, and other variables determined that women with AIDS cancers (but not non-AIDS cancers) were more likely to have sustained viremia (adjusted odds ratio [aOR] 1.94, P < 0.0001), as were African-American women (aOR 2.09, P < 0.0001) and women who died (aOR 1.71, P = 0.0002). Compared with women who had sustained viremia, those with viral suppression were 40% more likely to report cardiovascular risk factors including hypertension, hyperlipidemia, and diabetes (aOR 1.4, P = 0.0072). But viral suppression was not associated with an increased risk of cardiovascular outcomes (aOR 1.1, P = 0.4116).
The WIHS team concludes that longer cumulative duration of viral suppression is associated with lower mortality and a lower rate of cardiovascular events--but also with higher odds of reporting cardiovascular risk factors. The investigators did not speculate on reasons for the surprising higher risk factor rate with longer viral suppression. One possibility is that women with longer viral suppression were more accurate in reporting cardiovascular risk factors, or that their sharper awareness of cardiovascular risk led to better control of conditions like hypertension, hyperlipidemia, and diabetes—and thus to lower mortality.
Reference
1. Kassaye S, Wang C, Collmann J, et al. Longitudinal HIV viral trajectories and comorbidities in the WIHS. Conference on Retroviruses and Opportunistic Infections (CROI), February 13-16, 2017, Seattle. Abstract 646.
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