Age-standardized comparison of coronary artery disease, stroke incidence, and all-cause mortality between people living with HIV and the general population in Spain

Abstract

All-cause mortality; Coronary artery disease; General population

Mortalidad por todas las causas; Enfermedad arterial coronaria; Población general

Mortalitat per totes les causes; Malaltia arterial coronària; Població general

Objectives We compared 15-year incidence of coronary artery disease (CAD), stroke, and all-cause mortality between people living with HIV (PLWH) and the Spanish general population. Methods We compared two Spanish cohorts—VACH (PLWH) and REGICOR (general population). We followed adults aged 25-74 years, free of CAD or stroke, for a mean of 15 years. We used age-standardized 15-year incidence of CAD, stroke, and all-cause mortality and compared cohorts with log-rank tests and Cox models adjusted for confounders. Results We included 6829 PLWH and 10,218 general population. In men aged 25-54 years with HIV, the adjusted standardized incidence rates of CAD and stroke were similar to those in the general population. In addition, PLWH had significantly higher crude all-cause standardized mortality rates than the general population: men 2790 (2536-3044) vs 1104 (1015-1192) and women 2011 (1632-2391) vs 588 (528-648) (all P-values <0.001). Moreover, the adjusted hazard ratio of all-cause mortality was much higher in PLWH younger than 55 years (hazard ratio 3.08 [2.42-3.90] in men and 4.71 [3.13-7.09] in women). Conclusions The adjusted risk of CAD and stroke among PLWH is similar to that of the general population. However, PLWH younger than 55 years still face a more than three-fold higher risk of death from any cause.

This research was supported by CIBER -Consorcio Centro de Investigación Biomédica en Red- (CB16/11/00229 to JM and CB16/11/00246), Instituto de Salud Carlos III, Ministerio de Ciencia e Innovación and Unión Europea–European Regional Development Fund. Grants from the Health Department of the Generalitat de Catalunya through the Agència de Gestió d’Ajuts Universitaris de Recerca de Catalunya (AGAUR) [2021SGR144], Programa de Intensificación de Investigadores del Sistema Nacional de Salud [INT19/00036 to PD], and Gilead [GLD17-00224 and IN-ES-985-5373].