It is Time to Attach Importance to Effects of Cardiovascular Diseases Among People living with HIV Infection: A Systematic Review and Meta-analysis (Preprint)

BACKGROUND Various non-acquired immunodeficiency syndrome-related diseases, such as cardiovascular disease (CVD), affect the quality of life in people living with HIV (PLWH) and prognosis of acquired immunodeficiency syndrome (AIDS) in the post-active antiretroviral therapy (ART) era. However, little is known about the specific risk ratio between PLWH and HIV-negative individuals. We aimed to incorporate the evidence of HIV-related CVD and explore the risk factors. OBJECTIVE We systematically reviewed the evidence supporting the specific risk of CVD in PLWH. METHODS The PubMed, Embase, Web of Science, and Cochrane Library databases were searched to find cohort and cross-sectional studies that evaluated the risk of hypertension, dyslipidemia, coronary atherosclerosis diseases (CAD), and myocardial infarction (MI) in PLWH. The relative risk (RR), hazard rate (HR), odds ratio (OR), and 95% confidence interval (CI) were calculated for each study, and all were pooled using the random-effects model due to the expected variability among eligible studies. Subgroup and meta-regression analyses were performed to assess for heterogeneity. RESULTS A total of 29 studies that met the inclusion criteria were analyzed, which included 300,274 HIV-positive and 39,256,498 HIV-negative individuals. Compared with people without HIV, PLWH were associated with a higher risk of hypertension (HR = 1.28, 95% CI: 1.03–1.58), dyslipidemia (HR = 1.64, 95% CI: 1.38–1.94), CAD (HR = 1.37, 95% CI: 1.24–1.51), and MI (HR = 1.48, 95% CI: 1.28–1.72). Age, gender, body mass index (BMI) , region, smoking and time to initiate therapy had an impact on the risk of CVDs in PLWH. With aging, the pooled risk of hypertension and dyslipidemia slightly increased, while CAD decreased. Men with AIDS generally have a higher risk of hypertention(HR = 1.27, 95% CI: 1.01–1.61) and dyslipidemia(HR = 1.86, 95% CI: 1.56–2.22). A high BMI (obese/overweight) evidently increased the risk of dyslipidemia in PLWH (HR = 2.53, 95% CI: 1.43–4.47). The risks significantly varied in different regions, but PLWH generally had a higher risk of developing CVDs, especially hypertension and hyperlipidemia. And smoking explicitly related to the increased risk of most CVDs, except for hypertension. The earlier initiation of ART helps to decrease the risk of CVDs in PLWH. Significant heterogeneity was observed across studies for all outcomes analyzed (I2> 70%, P < 0.001), which was only partly explained by the available study-level characteristics. CONCLUSIONS The risk of CVD in PLWH is higher than that in the general population. Different targeted prevention strategies for CVD should be adopted according to the risk characteristics of PLWH of different ages in different regions. The HR of CVD in the post-ART era is relatively reduced, while the risk of dyslipidemia, CAD, and MI increases slightly with smoking. For dyslipidemia in PLWH, the risk increased in men and in people with a high BMI.