Incidence and risk factors of major cardiovascular events in a multicentre HIV cohort

Cardiovascular (CV) [1] and cerebrovascular [2] events threaten HIV subjects, affecting them earlier as compared to the general population and the current algorithms seem inadequate to estimate the CV risk, in particular concerning the weight of drugs, immunity and virus-related inflammation as risk factors. We analysed three Italian HIV cohorts from January 2005 to August 2011, extracting cases of acute myocardial infarction (AMI) or stroke. We analysed at the time of the event the subjects’ age, the risk factors, the Framingham score, the antiviral regimen and the time spent on each drug, the CDC stage, the nadir CD4 T cells and the outcome. Out of 4893 patients 92 experienced major CV events (76 AMI and 19 stroke, 2 subjects having both) and 10 died, at a median age of 50 years (range 33 77). Classical risk factors were widely represented, mainly smoke (72.8%) and dyslipidemia (53.3%). Three young subjects had no risk factors and dramatic coronary patterns, leading in one case to transplantation. No one ever had pathological bone fractures, and only 4/81 had GFR B60 mL/min (range 33.6 57.4). The median 10 years’ Framingham score was 10.5 (range 1 31). Abacavir had been taken by 19 subjects, equal to tenofovir and less than zidovudine (n 55), and lopinavir/ritonavir by 20, and no single drug emerged as risk. The median time spent on abacavir and/or on lopinavir/ritonavir was 48 weeks (range 1 552) and 106 weeks (range 8 256), respectively. One patient was antiretroviral naive. The CD4 nadir was 183/mm and 41.3% were CDC stage C. Although infrequent (1.8%), major CV events affect HIV people at younger age. Classical risk factors are common, while no drug effect emerged clearly. HIV infection was managed late in most of the patients. Early initiation of HAART [3] and reduction of risk factors seem the key points for preventing the occurrence of CV disease.