Global Burden of Atherosclerotic Cardiovascular Disease in People Living with the Human Immunodeficiency Virus: A Systematic Review and Meta-Analysis
Background—With advances in anti-retroviral therapy, most deaths in people with human immune-deficiency virus (HIV) are now due to non-communicable illnesses especially cardiovascular disease. We determine the association between HIV and cardiovascular disease, and estimate the national, regional and global burden of cardiovascular disease attributable to HIV.
Methods—We conducted a systematic review across five databases from inception to August 2016 for longitudinal studies of cardiovascular disease in HIV infection. A random-effects meta-analysis across eighty studies was used to derive the pooled rate and risk of cardiovascular disease in people living with HIV. We then estimated the temporal changes in the population attributable fraction and disability-adjusted life years (DALYs) from HIV associated cardiovascular disease from 1990 to 2015 at a regional and global level. National cardiovascular DALYs associated with HIV for 2015 were derived for 154 of the 193 United Nations member states. The main outcome measure was the pooled estimate of the rate and risk of cardiovascular disease in people living with HIV and the national, regional and global estimates of DALYs from cardiovascular disease associated with HIV.
Results—In 793,635 people living with HIV and a total follow-up of 3.5 million person-years, the crude rate of cardiovascular disease was 61.8 (95% confidence interval [CI] 45.8-83.4) per 10,000 person-years. Compared to individuals without HIV, the risk ratio for cardiovascular disease was 2.16 (95%CI 1.68-2.77). Over the last 26 years, the global population attributable fraction from cardiovascular disease due to HIV increased from 0.36% (95%CI 0.21-0.56%) to 0.92% (95%CI 0.55-1.41%) and DALYs increased from 0.74 (95%CI 0.44-1.16) to 2.57 (95%CI 1.53-3.92) million. There was marked regional variation with most DALYs lost in sub-Saharan Africa (0.87 million, 95%CI 0.43-1.70) and the Asia-Pacific (0.39 million, 95%CI 0.23-0.62) regions. The highest population attributable fraction and burden was observed in Swaziland, Botswana and Lesotho.
Conclusions—People living with HIV are twice as likely to develop cardiovascular disease. The global burden of HIV associated cardiovascular disease has tripled over the last two decades and is now responsible for 2.6 million DALYs per annum with the greatest impact in sub-Saharan Africa and the Asia-Pacific regions.
PROSPERO Registration—URL: https://www.crd.york.ac.uk/prospero Unique Identifier: CRD42016048257.
- Received December 22, 2017.
- Revision received May 18, 2018.
- Accepted June 5, 2018.