Associations between HIV viremia during antiretroviral therapy and cardiovascular disease
To investigate the association between HIV viremia exposure during antiretroviral therapy (ART) and cardiovascular disease (CVD) risk. Nationwide observational cohort. Participants (age >15 years) from the Swedish nationwide InfCareHIV register initiating ART 1996-2017 were categorized in a time-...
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| Veröffentlicht in: | AIDS (London) 2022-11, Vol.36 (13), p.1829-1834 |
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| creator | Elvstam, Olof Marrone, Gaetano Engström, Gunnar Nilsson, Peter M. Carlander, Christina Treutiger, Carl Johan Gisslén, Magnus Björkman, Per |
| description | To investigate the association between HIV viremia exposure during antiretroviral therapy (ART) and cardiovascular disease (CVD) risk.
Nationwide observational cohort.
Participants (age >15 years) from the Swedish nationwide InfCareHIV register initiating ART 1996-2017 were categorized in a time-updated manner into four viremia categories, starting from 12 months after ART initiation: suppression ( |
| doi_str_mv | 10.1097/QAD.0000000000003240 |
| format | Article |
| fullrecord | <record><control><sourceid>pubmed_swepu</sourceid><recordid>TN_cdi_swepub_primary_oai_swepub_ki_se_452612</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>35730359</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4970-9305f568f70c4eecdaacb66bf5973cd9768cf2d009be67bf23bbf647ee22aa493</originalsourceid><addsrcrecordid>eNp9kW1rFDEUhYModq3-A5H5A1Nv3icfl_rSwoIIKvgp3Lztjp3dWZKZLv33Zru1iqCBS8LDOecGDiGvKVxQMPrt5-W7C_jjcCbgCVlQoXkrpaZPyQKYMq3hGs7Ii1J-VJGErntOzrjUHLg0C_J9Wcroe5z6cVcaF6dDjLvm6vpbc9vnuO2xCXPud-sGd1MFUx4rx6GZNjHj_q7i0HjMoR9vsfh5wNyEvkQs8SV5lnAo8dXDfU6-fnj_5fKqXX36eH25XLVeGA31eyCTVF3S4EWMPiB6p5RL0mjug9Gq84kFAOOi0i4x7lxSQsfIGKIw_Jy0p9xyiPvZ2X3ut5jv7Ii9fUA39RWtkExRVvWrf-qHeV_H1TkaJGCg4JKlQaEV2njbcaCWJW8U6q4zXv13_brGVbS-T-PUcHHUi5Pe57GUHNOjg4I9FmtrsfbvYqvtzclWd2xjeDT9avJ37mEcppjLzTAfYrabiMO0uc9jwKFlwBilQKGthAL_CTtOsIU</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype></control><display><type>article</type><title>Associations between HIV viremia during antiretroviral therapy and cardiovascular disease</title><source>MEDLINE</source><source>EZB-FREE-00999 freely available EZB journals</source><creator>Elvstam, Olof ; Marrone, Gaetano ; Engström, Gunnar ; Nilsson, Peter M. ; Carlander, Christina ; Treutiger, Carl Johan ; Gisslén, Magnus ; Björkman, Per</creator><creatorcontrib>Elvstam, Olof ; Marrone, Gaetano ; Engström, Gunnar ; Nilsson, Peter M. ; Carlander, Christina ; Treutiger, Carl Johan ; Gisslén, Magnus ; Björkman, Per</creatorcontrib><description>To investigate the association between HIV viremia exposure during antiretroviral therapy (ART) and cardiovascular disease (CVD) risk.
Nationwide observational cohort.
Participants (age >15 years) from the Swedish nationwide InfCareHIV register initiating ART 1996-2017 were categorized in a time-updated manner into four viremia categories, starting from 12 months after ART initiation: suppression (<50 copies/ml), low-level viremia (50-199 copies/ml and 200-999 copies/ml, respectively), and high-level viremia (≥1000 copies/ml). In addition, cumulative viremia was estimated as the area under the log viral load (VL) curve. Proportional subhazard models adjusted for sex, age, pre-ART CD4 and VL, injection drug use, and country of birth were used to analyze the association between viremia exposure and CVD risk (ischemic heart disease, stroke, and heart failure; data obtained by linkage to national registers), accounting for the competing risk of non-CVD death.
In all, 337 cases of CVD were observed during 44 937 person-years of follow-up ( n = 6562). Higher viremia exposure was associated with CVD, both when parameterized as cumulative viremia (adjusted subhazard ratio [aSHR] per 1 log 10 copy × year/ml, 1.03; 95% confidence interval [CI], 1.01-1.05) and as viremia category (aSHR for high-level viremia versus suppression, 1.45; 95% CI, 1.03-2.05). We observed no association between CVD and low-level viremia compared with those with suppression.
Higher exposure to HIV viremia was linked to CVD in ART recipients, whereas no increased risk was detected for people with low-level viremia compared with viral suppression. Causal inference is limited by the observational nature of this study.</description><identifier>ISSN: 0269-9370</identifier><identifier>ISSN: 1473-5571</identifier><identifier>EISSN: 1473-5571</identifier><identifier>DOI: 10.1097/QAD.0000000000003240</identifier><identifier>PMID: 35730359</identifier><language>eng</language><publisher>England: Lippincott Williams & Wilkins</publisher><subject>Adolescent ; Anti-HIV Agents - adverse effects ; Cardiac and Cardiovascular Systems ; cardiovascular diseases ; Cardiovascular Diseases - chemically induced ; Cardiovascular Diseases - complications ; Cardiovascular Diseases - epidemiology ; care ; Clinical Medicine ; epidemiology ; Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi ; Health Sciences ; HIV infections ; HIV Infections - complications ; HIV Infections - drug therapy ; Humans ; Hälsovetenskap ; Immunology ; infected patients ; Infectious Diseases ; Infectious Medicine ; Infektionsmedicin ; ischemia ; Kardiologi ; Klinisk medicin ; low-level viremia ; Medical and Health Sciences ; Medicin och hälsovetenskap ; mortality ; myocardial ; myocardial-infarction ; people ; predictor ; progression ; Public Health, Global Health, Social Medicine and Epidemiology ; risk ; stroke ; Viral Load ; viremia ; Viremia - drug therapy ; Virology</subject><ispartof>AIDS (London), 2022-11, Vol.36 (13), p.1829-1834</ispartof><rights>Lippincott Williams & Wilkins</rights><rights>Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4970-9305f568f70c4eecdaacb66bf5973cd9768cf2d009be67bf23bbf647ee22aa493</citedby><cites>FETCH-LOGICAL-c4970-9305f568f70c4eecdaacb66bf5973cd9768cf2d009be67bf23bbf647ee22aa493</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35730359$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://gup.ub.gu.se/publication/319346$$DView record from Swedish Publication Index$$Hfree_for_read</backlink><backlink>$$Uhttps://lup.lub.lu.se/record/50ad10bf-1d6a-479c-8301-2fc96a7889c6$$DView record from Swedish Publication Index$$Hfree_for_read</backlink><backlink>$$Uhttp://kipublications.ki.se/Default.aspx?queryparsed=id:150792039$$DView record from Swedish Publication Index$$Hfree_for_read</backlink></links><search><creatorcontrib>Elvstam, Olof</creatorcontrib><creatorcontrib>Marrone, Gaetano</creatorcontrib><creatorcontrib>Engström, Gunnar</creatorcontrib><creatorcontrib>Nilsson, Peter M.</creatorcontrib><creatorcontrib>Carlander, Christina</creatorcontrib><creatorcontrib>Treutiger, Carl Johan</creatorcontrib><creatorcontrib>Gisslén, Magnus</creatorcontrib><creatorcontrib>Björkman, Per</creatorcontrib><title>Associations between HIV viremia during antiretroviral therapy and cardiovascular disease</title><title>AIDS (London)</title><addtitle>AIDS</addtitle><description>To investigate the association between HIV viremia exposure during antiretroviral therapy (ART) and cardiovascular disease (CVD) risk.
Nationwide observational cohort.
Participants (age >15 years) from the Swedish nationwide InfCareHIV register initiating ART 1996-2017 were categorized in a time-updated manner into four viremia categories, starting from 12 months after ART initiation: suppression (<50 copies/ml), low-level viremia (50-199 copies/ml and 200-999 copies/ml, respectively), and high-level viremia (≥1000 copies/ml). In addition, cumulative viremia was estimated as the area under the log viral load (VL) curve. Proportional subhazard models adjusted for sex, age, pre-ART CD4 and VL, injection drug use, and country of birth were used to analyze the association between viremia exposure and CVD risk (ischemic heart disease, stroke, and heart failure; data obtained by linkage to national registers), accounting for the competing risk of non-CVD death.
In all, 337 cases of CVD were observed during 44 937 person-years of follow-up ( n = 6562). Higher viremia exposure was associated with CVD, both when parameterized as cumulative viremia (adjusted subhazard ratio [aSHR] per 1 log 10 copy × year/ml, 1.03; 95% confidence interval [CI], 1.01-1.05) and as viremia category (aSHR for high-level viremia versus suppression, 1.45; 95% CI, 1.03-2.05). We observed no association between CVD and low-level viremia compared with those with suppression.
Higher exposure to HIV viremia was linked to CVD in ART recipients, whereas no increased risk was detected for people with low-level viremia compared with viral suppression. Causal inference is limited by the observational nature of this study.</description><subject>Adolescent</subject><subject>Anti-HIV Agents - adverse effects</subject><subject>Cardiac and Cardiovascular Systems</subject><subject>cardiovascular diseases</subject><subject>Cardiovascular Diseases - chemically induced</subject><subject>Cardiovascular Diseases - complications</subject><subject>Cardiovascular Diseases - epidemiology</subject><subject>care</subject><subject>Clinical Medicine</subject><subject>epidemiology</subject><subject>Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi</subject><subject>Health Sciences</subject><subject>HIV infections</subject><subject>HIV Infections - complications</subject><subject>HIV Infections - drug therapy</subject><subject>Humans</subject><subject>Hälsovetenskap</subject><subject>Immunology</subject><subject>infected patients</subject><subject>Infectious Diseases</subject><subject>Infectious Medicine</subject><subject>Infektionsmedicin</subject><subject>ischemia</subject><subject>Kardiologi</subject><subject>Klinisk medicin</subject><subject>low-level viremia</subject><subject>Medical and Health Sciences</subject><subject>Medicin och hälsovetenskap</subject><subject>mortality</subject><subject>myocardial</subject><subject>myocardial-infarction</subject><subject>people</subject><subject>predictor</subject><subject>progression</subject><subject>Public Health, Global Health, Social Medicine and Epidemiology</subject><subject>risk</subject><subject>stroke</subject><subject>Viral Load</subject><subject>viremia</subject><subject>Viremia - drug therapy</subject><subject>Virology</subject><issn>0269-9370</issn><issn>1473-5571</issn><issn>1473-5571</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kW1rFDEUhYModq3-A5H5A1Nv3icfl_rSwoIIKvgp3Lztjp3dWZKZLv33Zru1iqCBS8LDOecGDiGvKVxQMPrt5-W7C_jjcCbgCVlQoXkrpaZPyQKYMq3hGs7Ii1J-VJGErntOzrjUHLg0C_J9Wcroe5z6cVcaF6dDjLvm6vpbc9vnuO2xCXPud-sGd1MFUx4rx6GZNjHj_q7i0HjMoR9vsfh5wNyEvkQs8SV5lnAo8dXDfU6-fnj_5fKqXX36eH25XLVeGA31eyCTVF3S4EWMPiB6p5RL0mjug9Gq84kFAOOi0i4x7lxSQsfIGKIw_Jy0p9xyiPvZ2X3ut5jv7Ii9fUA39RWtkExRVvWrf-qHeV_H1TkaJGCg4JKlQaEV2njbcaCWJW8U6q4zXv13_brGVbS-T-PUcHHUi5Pe57GUHNOjg4I9FmtrsfbvYqvtzclWd2xjeDT9avJ37mEcppjLzTAfYrabiMO0uc9jwKFlwBilQKGthAL_CTtOsIU</recordid><startdate>20221101</startdate><enddate>20221101</enddate><creator>Elvstam, Olof</creator><creator>Marrone, Gaetano</creator><creator>Engström, Gunnar</creator><creator>Nilsson, Peter M.</creator><creator>Carlander, Christina</creator><creator>Treutiger, Carl Johan</creator><creator>Gisslén, Magnus</creator><creator>Björkman, Per</creator><general>Lippincott Williams & Wilkins</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>ADTPV</scope><scope>AOWAS</scope><scope>F1U</scope><scope>D95</scope></search><sort><creationdate>20221101</creationdate><title>Associations between HIV viremia during antiretroviral therapy and cardiovascular disease</title><author>Elvstam, Olof ; Marrone, Gaetano ; Engström, Gunnar ; Nilsson, Peter M. ; Carlander, Christina ; Treutiger, Carl Johan ; Gisslén, Magnus ; Björkman, Per</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4970-9305f568f70c4eecdaacb66bf5973cd9768cf2d009be67bf23bbf647ee22aa493</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Adolescent</topic><topic>Anti-HIV Agents - adverse effects</topic><topic>Cardiac and Cardiovascular Systems</topic><topic>cardiovascular diseases</topic><topic>Cardiovascular Diseases - chemically induced</topic><topic>Cardiovascular Diseases - complications</topic><topic>Cardiovascular Diseases - epidemiology</topic><topic>care</topic><topic>Clinical Medicine</topic><topic>epidemiology</topic><topic>Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi</topic><topic>Health Sciences</topic><topic>HIV infections</topic><topic>HIV Infections - complications</topic><topic>HIV Infections - drug therapy</topic><topic>Humans</topic><topic>Hälsovetenskap</topic><topic>Immunology</topic><topic>infected patients</topic><topic>Infectious Diseases</topic><topic>Infectious Medicine</topic><topic>Infektionsmedicin</topic><topic>ischemia</topic><topic>Kardiologi</topic><topic>Klinisk medicin</topic><topic>low-level viremia</topic><topic>Medical and Health Sciences</topic><topic>Medicin och hälsovetenskap</topic><topic>mortality</topic><topic>myocardial</topic><topic>myocardial-infarction</topic><topic>people</topic><topic>predictor</topic><topic>progression</topic><topic>Public Health, Global Health, Social Medicine and Epidemiology</topic><topic>risk</topic><topic>stroke</topic><topic>Viral Load</topic><topic>viremia</topic><topic>Viremia - drug therapy</topic><topic>Virology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Elvstam, Olof</creatorcontrib><creatorcontrib>Marrone, Gaetano</creatorcontrib><creatorcontrib>Engström, Gunnar</creatorcontrib><creatorcontrib>Nilsson, Peter M.</creatorcontrib><creatorcontrib>Carlander, Christina</creatorcontrib><creatorcontrib>Treutiger, Carl Johan</creatorcontrib><creatorcontrib>Gisslén, Magnus</creatorcontrib><creatorcontrib>Björkman, Per</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>SwePub</collection><collection>SwePub Articles</collection><collection>SWEPUB Göteborgs universitet</collection><collection>SWEPUB Lunds universitet</collection><jtitle>AIDS (London)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Elvstam, Olof</au><au>Marrone, Gaetano</au><au>Engström, Gunnar</au><au>Nilsson, Peter M.</au><au>Carlander, Christina</au><au>Treutiger, Carl Johan</au><au>Gisslén, Magnus</au><au>Björkman, Per</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Associations between HIV viremia during antiretroviral therapy and cardiovascular disease</atitle><jtitle>AIDS (London)</jtitle><addtitle>AIDS</addtitle><date>2022-11-01</date><risdate>2022</risdate><volume>36</volume><issue>13</issue><spage>1829</spage><epage>1834</epage><pages>1829-1834</pages><issn>0269-9370</issn><issn>1473-5571</issn><eissn>1473-5571</eissn><abstract>To investigate the association between HIV viremia exposure during antiretroviral therapy (ART) and cardiovascular disease (CVD) risk.
Nationwide observational cohort.
Participants (age >15 years) from the Swedish nationwide InfCareHIV register initiating ART 1996-2017 were categorized in a time-updated manner into four viremia categories, starting from 12 months after ART initiation: suppression (<50 copies/ml), low-level viremia (50-199 copies/ml and 200-999 copies/ml, respectively), and high-level viremia (≥1000 copies/ml). In addition, cumulative viremia was estimated as the area under the log viral load (VL) curve. Proportional subhazard models adjusted for sex, age, pre-ART CD4 and VL, injection drug use, and country of birth were used to analyze the association between viremia exposure and CVD risk (ischemic heart disease, stroke, and heart failure; data obtained by linkage to national registers), accounting for the competing risk of non-CVD death.
In all, 337 cases of CVD were observed during 44 937 person-years of follow-up ( n = 6562). Higher viremia exposure was associated with CVD, both when parameterized as cumulative viremia (adjusted subhazard ratio [aSHR] per 1 log 10 copy × year/ml, 1.03; 95% confidence interval [CI], 1.01-1.05) and as viremia category (aSHR for high-level viremia versus suppression, 1.45; 95% CI, 1.03-2.05). We observed no association between CVD and low-level viremia compared with those with suppression.
Higher exposure to HIV viremia was linked to CVD in ART recipients, whereas no increased risk was detected for people with low-level viremia compared with viral suppression. Causal inference is limited by the observational nature of this study.</abstract><cop>England</cop><pub>Lippincott Williams & Wilkins</pub><pmid>35730359</pmid><doi>10.1097/QAD.0000000000003240</doi><tpages>6</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0269-9370 |
| ispartof | AIDS (London), 2022-11, Vol.36 (13), p.1829-1834 |
| issn | 0269-9370 1473-5571 1473-5571 |
| language | eng |
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| source | MEDLINE; EZB-FREE-00999 freely available EZB journals |
| subjects | Adolescent Anti-HIV Agents - adverse effects Cardiac and Cardiovascular Systems cardiovascular diseases Cardiovascular Diseases - chemically induced Cardiovascular Diseases - complications Cardiovascular Diseases - epidemiology care Clinical Medicine epidemiology Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi Health Sciences HIV infections HIV Infections - complications HIV Infections - drug therapy Humans Hälsovetenskap Immunology infected patients Infectious Diseases Infectious Medicine Infektionsmedicin ischemia Kardiologi Klinisk medicin low-level viremia Medical and Health Sciences Medicin och hälsovetenskap mortality myocardial myocardial-infarction people predictor progression Public Health, Global Health, Social Medicine and Epidemiology risk stroke Viral Load viremia Viremia - drug therapy Virology |
| title | Associations between HIV viremia during antiretroviral therapy and cardiovascular disease |
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