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Severe infection increases cardiovascular risk among HIV-infected individuals

  • Mesquita, Emersom Cicilini1
  • Coelho, Lara Esteves2
  • Amancio, Rodrigo Teixeira1
  • Veloso, Valdilea2
  • Grinsztejn, Beatriz2
  • Luz, Paula2
  • Bozza, Fernando Augusto1, 3
  • 1 Fundação Oswaldo Cruz (FIOCRUZ), Laboratório de Pesquisa Clínica em Medicina Intensiva, Instituto Nacional de Infectologia Evandro Chagas (INI), Rio de Janeiro, Brazil , Rio de Janeiro (Brazil)
  • 2 Instituto de Nacional de Infectologia Evandro Chagas (INI), Laboratório de HIV, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil , Rio de Janeiro (Brazil)
  • 3 Instituto D’Or de Pesquisa e Ensino (IDOR), Rio de Janeiro, Brazil , Rio de Janeiro (Brazil)
Published Article
BMC Infectious Diseases
Springer (Biomed Central Ltd.)
Publication Date
Apr 11, 2019
DOI: 10.1186/s12879-019-3894-6
Springer Nature


BackgroundThe identification and management of cardiovascular risk factors became a major clinical issue among HIV-infected individuals in the post-cART era. As in the past decades the link between acute infections and cardiovascular diseases became clear in the general population, we sorted to investigate the role of severe infections on incident cardiovascular diseases (CVDs) among HIV-infected individuals.MethodsHIV-infected individuals aged ≥18 years, with no history of CVD were followed from January 2000 to December 2013 until the occurrence of the first CVD event, death or end of study, whichever occurred first. To explore the effect of severe infections on the incidence of CVD we used extended Cox regression models and stratified post-hospitalization follow-up time into three periods: < 3 months, 3–12 months and > 12 months post discharge.ResultsOne hundred-eighty four persons from 3384 HIV-infected individuals developed incident CVD events during the follow-up (incidence rate = 11.10/1000 PY (95%CI: 9.60–12.82)). Risk of an incident CVD was 4-fold higher at < 3 months post-hospitalization for severe infections (adjusted hazard ratio [aHR], 4.52; 95% confidence interval [CI] 2.46–8.30), after adjusting for sociodemographic and clinical factors as well as comorbidities. This risk remained significant up to one year (3–12 months post hospital discharge aHR 2.39, 95% CI 1.30–4.38). Additionally, non-white race/ethnicity (aHR 1.49, 95% CI 1.10–2.02), age ≥ 60 years (aHR 2.01, 95% CI 1.01–3.97) and hypertension (aHR 1.90, 95% CI 1.38–2.60) were associated with an increased risk of CVD events. High CD4 (≥ 500 cells/mm3: aHR 0.41, 95% CI 0.27–0.62) and cART use (aHR 0.21, 95% CI 0.14–0.31) reduced the risk of CVD events.ConclusionsWe provide evidence for a time-dependent association between severe infection and incident cardiovascular disease in HIV-infected individuals. cART use, and high CD4 count were significantly associated with reduced hazards of CVD.

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