A comparison of the risk for cardiovascular disease between HIV-infected and non-HIV-infected persons in Korea

Abstract

Background: Cardiovascular disease (CVD) is the most common cause of death worldwide. The introduction of highly active anti-retroviral therapy (HAART) has improved the quality of life and expanded the life expectancy of persons infected with human immunodeficiency virus type 1 (HIV-1). However, CVD is currently an increasing concern for HIV-infected persons and risk assessment is recommended as part of HIV patient care. Risk prediction tools such as the Framingham Risk Score (FRS) have been developed to identify patients at high CVD risk who may require therapeutic interventions. A number of articles have appeared regarding cardiovascular (CV) risk factors in HIV-infected persons who are naïve or treated with HAART. However, only a few publications have compared the risk factors for HIV-infected and non-HIV-infected persons(a healthy control group) in Korea. Methods: This study was designed as a cross-sectional study and was conducted at an outpatient clinic at the Severance Hospital, Yonsei University College of Medicine, and the Health Care Center of Yonsei Medical Center. The study investigated HIV-infected persons (N=116) who had been receiving HAART for more than 6 months and compared them to non-HIV-infected persons(a healthy control group) selected from age- and sex-matched persons who visited a health promotion center for periodic medical checkups (N=226). The aim of this study was to evaluate and compare the CV risk of HIV-infected and non-HIV-infected persons by calculating the Framingham Risk Scores (FRS). Results:The HIV-infected persons and non-HIV-infected persons (a healthy control group) did not differ by age (p=0.43) or gender (p=0.47). The HIV-infected persons had significantly higher levels of serum triglycerides, LDL cholesterol, and systolic blood pressure (p < 0.0001). The average 10-year risk for CV events (determined by FRS) was 7.07% (2-45) in the HIV-infected persons and 6.87% (1-37) in the non-HIV-infected persons (a healthy control group)(p= 0.77); both belonged to the very low risk group. Among HIV-infected persons, the FRS indicated low to moderate cardiovascular risk in 19.9 %, and high risk in 1.7%. In the non-HIV-infected persons, the FRS indicated low to moderate cardiovascular risk in 16.8%, and high risk in 2.7%(p = 0.57). No statistically significant effect on FRS was found for the HAART regimen, especially non-nucleoside reverse transcriptase inhibitor-based (NNRTI -based) (6.81 ± 4.4) versus protease inhibitor-based (PI-based) (7.26 ± 6.3) regimens (p=0.69).Conclusion: Approximately 70% of HIV infected persons were categorized into a low cardiovascular risk group. In addition, the 10-year cardiovascular risk prediction between HIV infected and non-HIV-infected persons was not significantly different (p=0.57). Based on these results, a long-term prospective cohort study for detecting the cardiovascular risks for HIV infected persons is considered.