Two-fold increased risk of cardiovascular events in people with MDR HIV: a matched cohort analysis with data from the PRESTIGIO registry
- Autori: Clemente, T.; Diotallevi, S.; Minisci, D.; Di Biagio, A.; Lolatto, R.; Attala, L.; Cenderello, G.; Siribelli, A.; Muccini, C.; Lo Caputo, S.; Tavio, M.; Papaioannu Borjesson, R.; Giacomelli, A.; Castagna, A.; Spagnuolo, V.; Null, N.; Castagna, A.; Spagnuolo, V.; Armenia, D.; Bonora, S.; Calza, L.; Cattelan, A.M.; Cenderello, G.; Cervo, A.; Comi, L.; Di Biagio, A.; Focà , E.; Gagliardini, R.; Giacomelli, A.; Lagi, F.; Marchetti, G.; Rusconi, S.; Saladini, F.; Santoro, M.M.; Zazzi, M.; Galli, A.; Armenia, D.; Saladini, F.; Santoro, M.M.; Zazzi, M.; Carini, E.; Bagaglio, S.; Piromall, G.; Lolatto, R.; Tavio, M.; Paggi, A.M.; Schioppa, O.; Da Ros, V.; Saracino, A.; Balena, F.; Comi, L.; Valenti, D.; Suardi, C.; Viale, P.; Calza, L.; Malerba, F.; Cretella, S.; Riccardi, R.; Castelli, F.; Focà , E.; Minisci, D.; Pennati, F.; Menzaghi, B.; Farinazzo, M.; Cacopardo, B.; Celesia, M.; Raddusa, M.S.P.; Giarratana, C.; Fusco, P.; Olivadese, V.; Pan, A.; Fornabaio, C.; Brambilla, P.; Bartoloni, A.; Lagi, F.; Corsi, P.; Kiros, S.T.; Ducci, F.; Giachè, S.; Costa, C.; Bellucci, A.; Mirabelli, E.; Santantonio, T.; Lo Caputo, S.; Ferrara, S.; Narducci, A.; Pontali, E.; Feasi, M.; Sarà , A.; Bassetti, M.; Di Biagio, A.; Blanchi, S.; Castagna, A.; Spagnuolo, V.; Muccini, C.; Carini, E.; Bagaglio, S.; Lolatto, R.; Galli, A.; Borjesson, R.P.; Clemente, T.; Piromalli, G.; Antinori, S.; Giacomelli, A.; Formenti, T.; Schiavo, F.; Marchetti, G.; Gazzola, L.; Fineo, F.T.; Puoti, M.; Moioli, C.; D'Amico, F.; Mussini, C.; Cervo, A.; Manzillo, E.; Lanzardo, A.; Cattelan, A.M.; Mazzitelli, M.; Cascio, A.; Trizzino, M.; Fronti, E.; Laccabue, D.; Carli, F.; Gulminetti, R.; Pagnucco, L.; Demitri, M.; Francisci, D.; De Socio, G.; Schiaroli, E.; Garlassi, E.; Corsini, R.; Gagliardini, R.; Fusto, M.; Sarmati, L.; Malagnino, V.; Mulas, T.; Torti, M.C.C.; Di Giambenedetto, S.; Lamonica, S.; Salvo, P.F.; Cenderello, G.; Pincino, R.; Tumbarello, M.; Fabbiani, M.; Panza, F.; Rancan, I.; Di Perri, G.; Bonora, S.; Ferrara, M.; Calcagno, A.; Fantino, S.; Nardi, S.; Fiscon, M.
- Anno di pubblicazione: 2025
- Tipologia: Articolo in rivista
- OA Link: http://hdl.handle.net/10447/696521
Abstract
Background: Major adverse cardiovascular events (MACEs) may contribute to the high morbidity in people with four-class drug-resistant HIV (4DR-PWH). Objectives: To explore the probability of MACEs in 4DR-PWH compared with non-4DR controls. Methods: This was a retrospective, propensity score-matched cohort study on 4DR-PWH (cases) and non-4DR-PWH (controls), on ART, without previous MACEs. Controls were matched with cases in a 4:1 ratio for age, sex-assigned-at-birth and ART duration. Incidence rates (IRs) and incidence rate ratio (IRR) of MACEs with 95% CIs were modelled by Poisson regression. Cumulative probabilities of the first incident MACE were estimated by Kaplan-Meier curves. A multivariable stepwise Cox proportional hazards model estimated predictors of incident MACEs among covariates with univariable P < 0.100. Results: Overall, 223 4DR-PWH and 797 non-4DR-PWH were evaluated. During a median (IQR) follow-up of 8.2 (5.4-11.1) years [1833 person-years of follow-up (PY)], 23/223 (10.3%) 4DR-PWH developed 29 MACEs, IR = 1.6 (95% CI = 1.1-2.3)/100 PY. During a median follow-up of 8.4 (5.2-11.0) years (6450 PY), 42/797 (5.3%) non-4DR controls had 45 MACEs, IR = 0.7 (95% CI = 0.5-0.9)/100 PY, IRR (4DR/non-4DR) = 2.3 (95% CI = 1.4-3.6). The cumulative probabilities of the first MACE were more than doubled in 4DR-PWH (P = 0.006). At multivariable analysis, an increased risk of MACEs was associated with 4DR status [adjusted hazard ratio (aHR) = 1.9; 95% CI = 1.0-3.4], after adjusting for age, sex-assigned-at-birth, HIV load, CD4+ nadir, total cholesterol, HDL cholesterol, diabetes mellitus, statin use and baseline HCV serostatus. Conclusions: In PWH, MDR is significantly associated with a higher risk of cardiovascular events. Prompt implementation of prevention strategies is mandatory in this fragile population.