Evaluation of risk factors of cardiovascular diseases in anti-retroviral treatment naive human immunodeficiency virus/acquired immunodeficiency syndrome patients / 中华传染病杂志

ABSTRACT

Objective:To investigate the risk factors of cardiovascular diseases (CVD) in human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) patients who did not receive anti-retroviral therapy (ART), and to provide reference for the follow-up ART scheme selection and CVD monitoring and management.Methods:A cross-sectional survey was conducted on 372 HIV/AIDS patients who did not initiate ART in the Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University from November 2018 to January 2020. According to the structured questionnaire, the basic information of HIV/AIDS patients, traditional risk factors of CVD (including smoking status, hypertension, diabetes, CVD family history) and HIV related factors were collected. The Framingham risk score and the data collection on adverse events of anti-HIV drugs (D∶A∶D (R)) score were used to evaluate the risk of CVD for 10 years. Logistic regression was used to analyze the influencing factors of CVD risk score≥10% in 10 years.Results:Among the 372 patients, 339(91.13%) were male and 33 (8.87%) were female. The age was 34(18, 80) years. The incidence of hypertension and diabetes were 12.20%(41/336) and 5.71%(21/368), respectively. There were 111 cases (30.16%, 111/368) with CD4 + T lymphocyte count <200/μL. Among 368 patients who underwent blood lipid test, high density lipoprotein-cholesterol (HDL-C) decreased in 199 cases (54.08%), triglyceride increased in 136 cases (36.96%), total cholesterol elevated in 44 cases (11.96%), and low density lipoprotein-cholesterol increased in 36 cases (9.78%). Statins were administrated in four cases (9.09%, 4/44). Among the 365 patients who met the D∶A∶D (R) score, age≥50 years old (odds ratio ( OR)=216.71, 95% confidence interval ( CI) 72.70-749.01, P<0.01) and HDL-C <1.0 mmol/L ( OR=6.35, 95% CI 2.22-18.09, P<0.01) were risk factors for 10-year CVD risk score≥10%. Among 233 patients who met the requirements of Framingham score, age≥50 years old ( OR=7.79, 95% CI 3.24-18.75, P<0.01) and CD4 + T lymphocyte count <200/μL( OR=1.88, 95% CI 0.10-3.56, P<0.05) were risk factors for 10-year CVD risk≥10%. Conclusions:There are many CVD risk factors among patients who have not initiated ART. The patients have high scores of 10-year CVD risk, while the intervention rate is low. Patients have higher CVD risks when age≥50 years old, CD4 + T lymphocyte count <200/μL and HDL-C <1.0 mmol/L. Therefore, screening and risk assessment of CVD risk factors should be included in the routine management and care of HIV/AIDS patients without ART initiation.