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Epidemiology of cardiovascular disease and risk factors in HIV-infected patients

Judith S Currier, MD
Section Editor
John G Bartlett, MD
Deputy Editor
Howard Libman, MD, FACP


For patients who have access to antiretroviral therapy (ART), the overall incidence of AIDS and death related to HIV infection has decreased dramatically [1]. Prior to 1996, the annual mortality among individuals with HIV infection exceeded 20 percent; this rate declined to <2 percent a decade later with the availability of effective treatment [2]. However, following the introduction of ART, new concerns arose about drug toxicities, including body fat maldistribution and metabolic abnormalities (eg, dyslipidemia, diabetes mellitus), and their potential association with cardiovascular disease [3-6].

This topic addresses the epidemiology of cardiovascular morbidity and mortality and cardiovascular risk factors in the setting of HIV infection and treatment. The incidence of subclinical atherosclerosis and the pathogenesis of cardiovascular disease in HIV-infected patients are discussed elsewhere. (See "Pathogenesis and biomarkers of cardiovascular disease in HIV-infected patients".)

Management of dyslipidemia in HIV-infected patients, HIV lipodystrophy, and HIV-associated cardiac complications, such as pericarditis, myocarditis, pulmonary hypertension, and cardiomyopathy, are also discussed separately. (See "Management of cardiovascular risk (including dyslipidemia) in the HIV-infected patient" and "Cardiac and vascular disease in HIV-infected patients" and "Epidemiology, clinical manifestations, and diagnosis of HIV-associated lipodystrophy".)


With more effective and widespread treatment of HIV in resource-rich settings, morbidity and mortality from non-AIDS-related events have surpassed those from AIDS-related events [7-9]. In particular, cardiovascular disease has emerged as an important cause of death in HIV-infected patients relative to the decreasing incidence of opportunistic disease. Several lines of evidence, from modeling of calculated cardiovascular risk to clinical studies evaluating such hard endpoints as stroke, myocardial infarctions (MIs), and sudden cardiac death have cumulatively supported this finding [10-16]. The data evaluating the rate of cardiovascular disease in HIV-infected patients compared with uninfected populations and its association with antiretroviral therapy (ART) and HIV disease state are discussed below.

Incidence compared with uninfected populations — Several studies have analyzed large clinical databases and cohorts in the United States, Canada, and Europe to compare the incidence of cardiovascular disease in patients with and without HIV infection [17-27]. Although some of these studies are limited by low number of events, short follow-up, and incomplete assessments of other cardiac risk factors, they consistently report a 1.5-fold increase in the rate of cardiovascular events in HIV-infected individuals compared with control populations. One of the largest of these studies evaluated California state-sponsored health insurance claims data, which included 28,513 HIV-infected and 3,054,696 uninfected patients [19]. The incidence of coronary heart disease (CHD) (including acute MI, other ischemic heart disease, and coronary atherosclerosis) in patients between the ages of 18 and 24 years was low overall but increased in those infected with HIV compared with the uninfected (relative risk [RR] 6.76, 95% CI 3.36–13.58 for men and 2.47, 95% CI 1.23–4.95, for women). The relative risk of CHD was the most increased in HIV-infected patients over the age of 45 years compared with uninfected populations.

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Literature review current through: Nov 2017. | This topic last updated: Sep 26, 2017.
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