AIDS (London, England) · 2026
Major ECG abnormalities and risk of incident cardiovascular disease in people with HIV compared to people without HIV.
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Vanbellinghen Manon C, van der Wulp Iris A J, Postema Pieter G, Kors Jan A, van der Loeff Maarten F Schim, Reiss Peter, van der Valk Marc, Boyd Anders
Аннотация
OBJECTIVES: People with HIV (PWH) have an increased risk of cardiovascular disease (CVD). In the general population, major electrocardiographic (ECG) abnormalities have been associated with increased risk of incident CVD. We compared the role of major ECG abnormalities in CVD between PWH and people without HIV (PWoH).
METHODS: PWH and PWoH with ≥1 ECG across six biennial study visits and without prior CVD were included. Transition intensities (TI) between: no major ECG abnormality, major ECG abnormality, and CVD were estimated using a multistate Markov model. Hazard ratios (HRs) were adjusted for age and BMI. Post hoc analyses explored whether inflammatory markers influenced the association between HIV-status and transitions.
RESULTS: Overall, 1060 participants were included (540 PWH and 520 PWoH; median age = 52 years, IQR = 48-58). During a median follow-up of 10.8 years interquartile range, (IQR = 6.8-11.0), 69 (12.8%) PWH and 52 (10.0%) PWoH had any major ECG abnormality ( P = 0.16), while 65 (12%) PWH and 41 (8%) PWoH ( P = 0.024) had an incident CVD event. There were 55 transitions from no major abnormality to major abnormality (TI = 0.76/100PY, 95% CI = 0.58-1.00) with no difference between PWH and PWoH (adjusted-HR = 1.57, 95% CI = 0.92-2.68). There were 18 transitions from major abnormality to CVD (TI = 3.38/100PY, 95% CI = 1.98-5.75), with a significantly higher TI for PWH (adjusted-HR = 3.24, 95% CI = 1.11-9.55). Adjustment for interleukin-6 attenuated the HR of HIV for this transition by 16%.
CONCLUSION: PWH with major ECG abnormalities had a significantly higher risk of incident CVD than PWoH, possibly related to systemic inflammation. Given the low probability of developing these abnormalities, routine ECG screening is unlikely to be of benefit.
METHODS: PWH and PWoH with ≥1 ECG across six biennial study visits and without prior CVD were included. Transition intensities (TI) between: no major ECG abnormality, major ECG abnormality, and CVD were estimated using a multistate Markov model. Hazard ratios (HRs) were adjusted for age and BMI. Post hoc analyses explored whether inflammatory markers influenced the association between HIV-status and transitions.
RESULTS: Overall, 1060 participants were included (540 PWH and 520 PWoH; median age = 52 years, IQR = 48-58). During a median follow-up of 10.8 years interquartile range, (IQR = 6.8-11.0), 69 (12.8%) PWH and 52 (10.0%) PWoH had any major ECG abnormality ( P = 0.16), while 65 (12%) PWH and 41 (8%) PWoH ( P = 0.024) had an incident CVD event. There were 55 transitions from no major abnormality to major abnormality (TI = 0.76/100PY, 95% CI = 0.58-1.00) with no difference between PWH and PWoH (adjusted-HR = 1.57, 95% CI = 0.92-2.68). There were 18 transitions from major abnormality to CVD (TI = 3.38/100PY, 95% CI = 1.98-5.75), with a significantly higher TI for PWH (adjusted-HR = 3.24, 95% CI = 1.11-9.55). Adjustment for interleukin-6 attenuated the HR of HIV for this transition by 16%.
CONCLUSION: PWH with major ECG abnormalities had a significantly higher risk of incident CVD than PWoH, possibly related to systemic inflammation. Given the low probability of developing these abnormalities, routine ECG screening is unlikely to be of benefit.