Affiliations 

  • 1 The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
  • 2 YRGCARE Medical Centre, Chennai, India
  • 3 Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
  • 4 Institute of Infectious Diseases, Pune, India
  • 5 Queen Elizabeth Hospital, Kowloon, Hong Kong
  • 6 Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
  • 7 Taipei Veterans General Hospital, Taipei, Taiwan
  • 8 University Malaya Medical Centre, Kuala Lumpur, Malaysia
  • 9 Chiangrai Prachanukroh Hospital, Chiang Rai, Thailand
  • 10 HIV-NAT/The Thai Red Cross AIDS Research Centre, Bangkok, Thailand
  • 11 National Hospital for Tropical Diseases, Hanoi, Vietnam
  • 12 National Center for Global Health and Medicine, Tokyo, Japan
  • 13 Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
  • 14 Hospital Sungai Buloh, Sungai Buloh, Malaysia
  • 15 Faculty of Medicine Udayana University & Sanglah Hospital, Bali, Indonesia
  • 16 Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
  • 17 Research Institute for Tropical Medicine, Manila, Philippines
  • 18 Working Group on AIDS, Faculty of Medicine, University of Indonesia/Cipto Mangunkusumo Hospital, Jakarta, Indonesia
  • 19 National Center for HIV/AIDS, Dermatology & STDs, and University of Health Sciences, Phnom Penh, Cambodia
  • 20 Bach Mai Hospital, Hanoi, Vietnam
  • 21 TREAT Asia, amfAR - The Foundation for AIDS Research, Bangkok, Thailand
PMID: 30833516 DOI: 10.3851/IMP3298

Abstract

BACKGROUND: We aimed to project the 10-year future incidence of CVD and model several intervention scenarios based on a multi-site Asian HIV-positive cohort.

METHODS: Analyses were based on patients recruited to the TREAT Asia HIV Observational Database (TAHOD), consisting of 21 sites in 12 countries. Patients on triple antiretroviral therapy (ART) were included if they were alive, without previous CVD, and had data on CVD risk factors. Annual new CVD events for 2019-2028 were estimated with the D:A:D equation, accounting for age- and sex-adjusted mortality. Modelled intervention scenarios were treatment of high total cholesterol, low high-density lipoprotein cholesterol (HDL) or high blood pressure, abacavir or lopinavir substitution, and smoking cessation.

RESULTS: Of 3703 included patients, 69% were male, median age was 46 (IQR 40-53) years, and median time since ART initiation was 9.8 years (IQR 7.5-14.1). Cohort incidence rates of CVD were projected to increase from 730 per 100,000 person-years (pys) in 2019 to 1432 per 100,000 pys in 2028. In the modelled intervention scenarios, most events can be avoided by smoking cessation, abacavir substitution, lopinavir substitution, decreasing total cholesterol, treating high blood pressure, and increasing HDL.

CONCLUSIONS: Our projections suggest a doubling of CVD incidence rates in Asian HIV-positive adults in our cohort. An increase in CVD can be expected in any aging population, however, according to our models, this can be close to averted by interventions. Thus, there is an urgent need for risk screening and integration of HIV and CVD programmes to reduce the future CVD burden.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.