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COVID-19 increases risk of severe cardiovascular problems in people with HIV

COVID-19 was associated with a 30% increased risk of major CVE in PWH during the subsequent year. This suggests that COVID-19 should be considered an additional CVD risk in PWH in the short term.

Photo by Keagan Henman from Unsplash.com

People living with HIV who have experienced an episode of COVID-19 face a significant increase in the risk of cardiovascular diseases in the year following infection.

This is according to a study – “Major cardiovascular events after COVID-19 in people with HIV” by Raquel Martín-Iguacel, Sergio Moreno-Fornés, Andreu Bruguera, et al – that appeared in the Clinical Microbiology and Infection.

To assess the effect of COVID-19 on the postacute risk of cardiovascular events (CVEs) among people with HIV (PWH), this study tapped all PWH ≥16 years in the Catalan PISCIS HIV cohort, including 4,199 PWH with and 14,004 PWH without COVID-19. The researchers estimated the incidence rate of the first CVE after COVID-19, analyzed it a composite outcome (2020–2022), and then adjusted for baseline differences using inverse probability weighting and used competing risk analysis.

Key findings included:

  • Overall, 211 PWH with COVID-19 and 621 without developed CVE, with an incidence rate of 70.2 and 56.8/1000 person-years, respectively.
  • During COVID-19 infection, 7.6% (320/4199) required hospitalization and 0.6% (25/4199) intensive care unit admission, 97% (4079/4199) had CD4+T-cell ≥200 cells/μL, 90% (3791/4199) had HIV-RNA<50 copies/mL and 11.8% (496/4199) had previous CVE at baseline.
  • The cumulative CVE incidence was higher among PWH after COVID-19 compared with PWH without COVID-19 during the first year (log-rank p=0.011).
  • The multivariable analysis identified significantly increased CVE risk with age, heterosexual men, previous cardiovascular disease (CVD), and chronic kidney or liver disease. COVID-19 was associated with increased subsequent risk of CVE (adjusted hazard ratio 1.30 [95% CI, 1.09–1.55]), also when only including individuals without previous CVD (1.60 [95% CI, 1.11–2.29]) or nonhospitalized patients (1.34 [95% CI, 1.11–1.62]).

In a gist, “COVID-19 was associated with a 30% increased risk of major CVE in PWH during the subsequent year,” stressed the researchers, adding that this “suggests that COVID-19 should be considered an additional CVD risk in PWH in the short term.”

There is, therefore, a need to deal with the identified factors associated with an increased risk of CVD among PWH, “including age, being a heterosexual man or woman, the presence of previous cardiovascular disease, and other conditions such as chronic kidney or liver disease.”

According to co-author Martín-Iguacel: “It is vital to urge patients who have had COVID-19 to be aware of this increased risk and to manage other cardiovascular risk factors, such as smoking, diabetes, hypertension, or high cholesterol”.

The researchers hope for the study to serve as “a warning to physicians taking care of individuals with HIV, who will need to consider this increased cardiovascular risk during the first year post-COVID. There are various therapeutic strategies under study to mitigate this risk that must be closely monitored.”

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