Advertisement

Patterns of Cardiovascular Mortality for HIV-Infected Adults in the United States: 1999 to 2013

Published:November 05, 2015DOI:https://doi.org/10.1016/j.amjcard.2015.10.030
      With widespread availability and the use of antiretroviral therapy, patients with human immunodeficiency virus (HIV) in the United States are living long enough to experience non-AIDS–defining illnesses. HIV is associated with an increased risk for cardiovascular disease (CVD) because of traditional CVD risk factors, residual virally mediated inflammation despite HIV treatment, and side effects of antiretroviral therapy. No United States population-wide studies have evaluated patterns of CVD mortality for HIV-infected subjects. Our central hypothesis was that the proportionate mortality from CVD (CVD mortality/total mortality) in the HIV-infected population increased from 1999 to 2013. We used the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research online database of the United States public health data to assess proportionate CVD mortality from 1999 to 2013 in the HIV-infected, general, and inflammatory polyarthropathy populations; the inflammatory polyarthropathy population was included as a positive control group. Total mortality in the HIV-infected population decreased from 15,739 in 1999 to 8,660 in 2013; however, CVD mortality increased from 307 to 400 during the same period. Thus, proportionate CVD mortality for the HIV-infected population increased significantly from 1999 to 2013 (p <0.0001); this pattern was consistent across races, particularly for men. In contrast, proportionate CVD mortality decreased for the general and inflammatory polyarthropathy populations from 1999 to 2013. In conclusion, CVD has become an increasingly common cause of death in HIV-infected subjects since 1999; understanding evolving mortality risks in the HIV-infected population is essential to inform routine clinical care of HIV-infected subjects as well as CVD prevention and treatment.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Palella Jr., F.J.
        • Baker R.K.
        • Moorman A.C.
        • Chmiel J.S.
        • Wood K.C.
        • Brooks J.T.
        • Holmberg S.D.
        • HIV Outpatient Study Investigators
        Mortality in the highly active antiretroviral therapy era: changing causes of death and disease in the HIV outpatient study.
        J Acquir Immune Defic Syndr. 2006; 43: 27-34
        • Rodger A.J.
        • Lodwick R.
        • Schechter M.
        • Deeks S.
        • Amin J.
        • Gilson R.
        • Paredes R.
        • Bakowska E.
        • Engsig F.N.
        • Phillips A.
        • INSIGHT SMART ESPRIT Study Groups
        Mortality in well controlled HIV in the continuous antiretroviral therapy arms of the SMART and ESPRIT trials compared with the general population.
        AIDS. 2013; 27: 973-979
        • Go A.S.
        • Mozaffarian D.
        • Roger V.L.
        • Benjamin E.J.
        • Berry J.D.
        • Blaha M.J.
        • Dai S.
        • Ford E.S.
        • Fox C.S.
        • Franco S.
        • Fullerton H.J.
        • Gillespie C.
        • Hailpern S.M.
        • Heit J.A.
        • Howard V.J.
        • Huffman M.D.
        • Judd S.E.
        • Kissela B.M.
        • Kittner S.J.
        • Lackland D.T.
        • Lichtman J.H.
        • Lisabeth L.D.
        • Mackey R.H.
        • Magid D.J.
        • Marcus G.M.
        • Marelli A.
        • Matchar D.B.
        • McGuire D.K.
        • Mohler 3rd, E.R.
        • Moy C.S.
        • Mussolino M.E.
        • Neumar R.W.
        • Nichol G.
        • Pandey D.K.
        • Paynter N.P.
        • Reeves M.J.
        • Sorlie P.D.
        • Stein J.
        • Towfighi A.
        • Turan T.N.
        • Virani S.S.
        • Wong N.D.
        • Woo D.
        • Turner M.B.
        • American Heart Association Statistics Committee and Stroke Statistics Subcommittee
        Executive summary: heart disease and stroke statistics–2014 update: a report from the American Heart Association.
        Circulation. 2014; 129: 399-410
        • Chow F.C.
        • Regan S.
        • Feske S.
        • Meigs J.B.
        • Grinspoon S.K.
        • Triant V.A.
        Comparison of ischemic stroke incidence in HIV-infected and non-HIV-infected patients in a US health care system.
        J Acquir Immune Defic Syndr. 2012; 60: 351-358
        • Triant V.A.
        • Meigs J.B.
        • Grinspoon S.K.
        Association of C-reactive protein and HIV infection with acute myocardial infarction.
        J Acquir Immune Defic Syndr. 2009; 51: 268-273
        • Butt A.A.
        • Chang C.C.
        • Kuller L.
        • Goetz M.B.
        • Leaf D.
        • Rimland D.
        • Gibert C.L.
        • Oursler K.K.
        • Rodriguez-Barradas M.C.
        • Lim J.
        • Kazis L.E.
        • Gottlieb S.
        • Justice A.C.
        • Freiberg M.S.
        Risk of heart failure with human immunodeficiency virus in the absence of prior diagnosis of coronary heart disease.
        Arch Intern Med. 2011; 171: 737-743
        • Tseng Z.H.
        • Secemsky E.A.
        • Dowdy D.
        • Vittinghoff E.
        • Moyers B.
        • Wong J.K.
        • Havlir D.V.
        • Hsue P.Y.
        Sudden cardiac death in patients with human immunodeficiency virus infection.
        J Am Coll Cardiol. 2012; 59: 1891-1896
        • Paisible A.L.
        • Chang C.C.
        • So-Armah K.A.
        • Butt A.A.
        • Leaf D.A.
        • Budoff M.
        • Rimland D.
        • Bedimo R.
        • Goetz M.B.
        • Rodriguez-Barradas M.C.
        • Crane H.M.
        • Gibert C.L.
        • Brown S.T.
        • Tindle H.A.
        • Warner A.L.
        • Alcorn C.
        • Skanderson M.
        • Justice A.C.
        • Freiberg M.S.
        HIV infection, cardiovascular disease risk factor profile, and risk for acute myocardial infarction.
        J Acquir Immune Defic Syndr. 2015; 68: 209-216
        • Zhang S.
        • van Sighem A.
        • Kesselring A.
        • Gras L.
        • Smit C.
        • Prins J.M.
        • Kauffmann R.
        • Richter C.
        • de Wolf F.
        • Reiss P.
        Episodes of HIV viremia and the risk of non-AIDS diseases in patients on suppressive antiretroviral therapy.
        J Acquir Immune Defic Syndr. 2012; 60: 265-272
        • Triant V.A.
        • Regan S.
        • Lee H.
        • Sax P.E.
        • Meigs J.B.
        • Grinspoon S.K.
        Association of immunologic and virologic factors with myocardial infarction rates in a US healthcare system.
        J Acquir Immune Defic Syndr. 2010; 55: 615-619
        • Stein J.H.
        • Hsue P.Y.
        Inflammation, immune activation, and CVD risk in individuals with HIV infection.
        JAMA. 2012; 308: 405-406
        • Tien P.C.
        • Choi A.I.
        • Zolopa A.R.
        • Benson C.
        • Tracy R.
        • Scherzer R.
        • Bacchetti P.
        • Shlipak M.
        • Grunfeld C.
        Inflammation and mortality in HIV-infected adults: analysis of the FRAM study cohort.
        J Acquir Immune Defic Syndr. 2010; 55: 316-322
        • Currier J.S.
        • Lundgren J.D.
        • Carr A.
        • Klein D.
        • Sabin C.A.
        • Sax P.E.
        • Schouten J.T.
        • Smieja M.
        • Working Group 2
        Epidemiological evidence for cardiovascular disease in HIV-infected patients and relationship to highly active antiretroviral therapy.
        Circulation. 2008; 118: e29-e35
        • Pearce D.
        • Ani C.
        • Espinosa-Silva Y.
        • Clark R.
        • Fatima K.
        • Rahman M.
        • Diebolt E.
        • Ovbiagele B.
        Comparison of in-hospital mortality from acute myocardial infarction in HIV sero-positive versus sero-negative individuals.
        Am J Cardiol. 2012; 110: 1078-1084
        • Smit C.
        • Geskus R.
        • Walker S.
        • Sabin C.
        • Coutinho R.
        • Porter K.
        • Prins M.
        • CASCADE Collaboration
        Effective therapy has altered the spectrum of cause-specific mortality following HIV seroconversion.
        AIDS. 2006; 20: 741-749
        • Ingle S.M.
        • May M.T.
        • Gill M.J.
        • Mugavero M.J.
        • Lewden C.
        • Abgrall S.
        • Fatkenheuer G.
        • Reiss P.
        • Saag M.S.
        • Manzardo C.
        • Grabar S.
        • Bruyand M.
        • Moore D.
        • Mocroft A.
        • Sterling T.R.
        • D'Arminio Monforte A.
        • Hernando V.
        • Teira R.
        • Guest J.
        • Cavassini M.
        • Crane H.M.
        • Sterne J.A.
        • Antiretroviral Therapy Cohort Collaboration
        Impact of risk factors for specific causes of death in the first and subsequent years of antiretroviral therapy among HIV-infected patients.
        Clin Infect Dis. 2014; 59: 287-297
        • Hamideh D.
        • Alvarez O.
        Sickle cell disease related mortality in the United States (1999-2009).
        Pediatr Blood Cancer. 2013; 60: 1482-1486
        • Lott J.P.
        • Gross C.P.
        Mortality from nonneoplastic skin disease in the United States.
        J Am Acad Dermatol. 2014; 70 (e41): 47-54
        • Davis F.G.
        • Dolecek T.A.
        • McCarthy B.J.
        • Villano J.L.
        Toward determining the lifetime occurrence of metastatic brain tumors estimated from 2007 United States cancer incidence data.
        Neuro Oncol. 2012; 14: 1171-1177
        • van Halm V.P.
        • Peters M.J.
        • Voskuyl A.E.
        • Boers M.
        • Lems W.F.
        • Visser M.
        • Stehouwer C.D.
        • Spijkerman A.M.
        • Dekker J.M.
        • Nijpels G.
        • Heine R.J.
        • Bouter L.M.
        • Smulders Y.M.
        • Dijkmans B.A.
        • Nurmohamed M.T.
        Rheumatoid arthritis versus diabetes as a risk factor for cardiovascular disease: a cross-sectional study, the CARRE investigation.
        Ann Rheum Dis. 2009; 68: 1395-1400
        • de Groot L.
        • Posthumus M.D.
        • Kallenberg C.G.
        • Bijl M.
        Risk factors and early detection of atherosclerosis in rheumatoid arthritis.
        Eur J Clin Invest. 2010; 40: 835-842
        • de Groot L.
        • Jager N.A.
        • Westra J.
        • Smit A.J.
        • Kallenberg C.G.
        • Posthumus M.D.
        • Bijl M.
        Does reduction of disease activity improve early markers of cardiovascular disease in newly diagnosed rheumatoid arthritis patients?.
        Rheumatology. 2015; 54: 1257-1261
        • Chauhan K.
        • Ackerman M.J.
        • Crowson C.S.
        • Matteson E.L.
        • Gabriel S.E.
        Population-based study of QT interval prolongation in patients with rheumatoid arthritis.
        Clin Exp Rheumatol. 2015; 33: 84-89
        • Roubille C.
        • Richer V.
        • Starnino T.
        • McCourt C.
        • McFarlane A.
        • Fleming P.
        • Siu S.
        • Kraft J.
        • Lynde C.
        • Pope J.
        • Gulliver W.
        • Keeling S.
        • Dutz J.
        • Bessette L.
        • Bissonnette R.
        • Haraoui B.
        The effects of tumour necrosis factor inhibitors, methotrexate, non-steroidal anti-inflammatory drugs and corticosteroids on cardiovascular events in rheumatoid arthritis, psoriasis and psoriatic arthritis: a systematic review and meta-analysis.
        Ann Rheum Dis. 2015; 74: 480-489
        • Aboud M.
        • Elgalib A.
        • Pomeroy L.
        • Panayiotakopoulos G.
        • Skopelitis E.
        • Kulasegaram R.
        • Dimian C.
        • CL F.
        • Duncan A.
        • Wierzbicki A.S.
        • Peters B.S.
        Cardiovascular risk evaluation and antiretroviral therapy effects in an HIV cohort: implications for clinical management: the CREATE 1 study.
        Int J Clin Pract. 2010; 64: 1252-1259
        • Friis-Moller N.
        • Thiebaut R.
        • Reiss P.
        • Weber R.
        • Monforte A.D.
        • De Wit S.
        • El-Sadr W.
        • Fontas E.
        • Worm S.
        • Kirk O.
        • Phillips A.
        • Sabin C.A.
        • Lundgren J.D.
        • Law M.G.
        • DAD Study Group
        Predicting the risk of cardiovascular disease in HIV-infected patients: the data collection on adverse effects of anti-HIV drugs study.
        Eur J Cardiovasc Prev Rehabil. 2010; 17: 491-501
        • Feinstein M.J.
        • Achenbach C.J.
        • Stone N.J.
        • Lloyd-Jones D.M.
        A systematic review of the usefulness of statin therapy in HIV-infected patients.
        Am J Cardiol. 2015; 115: 1760-1766
        • Henderson T.
        • Shepheard J.
        • Sundararajan V.
        Quality of diagnosis and procedure coding in ICD-10 administrative data.
        Med Care. 2006; 44: 1011-1019
        • Quan H.
        • Li B.
        • Saunders L.D.
        • Parsons G.A.
        • Nilsson C.I.
        • Alibhai A.
        • Ghali W.A.
        • IMECCHI Investigators
        Assessing validity of ICD-9-CM and ICD-10 administrative data in recording clinical conditions in a unique dually coded database.
        Health Serv Res. 2008; 43: 1424-1441