HIV-1-infected inmates have an increased prevalence of some particular comorbidities. However, the cardiovascular risk(CVR) of this population has rarely been evaluated.
Methods
Cross-sectional study carried out among 216 male HIV-1 patients in prison. Patients were stratified according to age(<34, 35-39, 40-44, 45-49, 50-54 and >55 years old, respectively)and their CVR was assessed by Framingham(FRAM) equation. The prevalence of some further risk factors was also evaluated: time on antiretroviral therapy, nadir CD4 count, maximum viral load(VL), time on undetectable VL, HCV-coinfection, and cocaine use.
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Results
Patients median age was 41 years(36-46), their median CD4 count was 386(240- 549)cells, 68% had an undetectable(<50 c/mL)VL, median nadir CD4 count was 207(104-315)cells, and 48% of them had a nadir CD4 count <200 cells. HCV-coinfection prevalence was 94%, cocaine consumption prevalence was 93.1%, and 54.2% of them were intravenous cocaine users. The FRAM 10-years CVR score among subjects studied was 5.88%. Figure 1 and Table 1.
Figure 1
CVR stratified by age group.
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Table 1
Cardiovascular risk factors prevalence stratified by age group.
Age
Smokers
Diabetes
Hypertension
Tot Chol > 200
HDL Chol <39
<34
99,44%
0,00%
8,33%
13,89%
72,22%
35-39
100%
3,23%
8,07%
8,07%
43,55%
40-44
100%
3,60%
12,50%
23,20%
51,80%
45-49
100%
0,00%
4,65%
9,31%
60,00%
50-54
100%
26,67%
20%
13,34%
46,00%
55-60
100%
0,00%
75%
100%
0,00%
Overall prevalence
99,07%
3,70%
10,60%
15,27%
53,24%
P
0,455
0,029
0,023
0,001
0,029
Age(p<0.001), total cholesterol(p<0.001), HDL cholesterol(p = 0.029), diabetes mellitus(p = 0.029), hypertension(p = 0.023), and nadir CD4 <200 cells(p = 0.04) were significantly associated with an increased CVR. Smoking, chronic HCV-hepatitis, cocaine use, and the HIV-1 VL were not significantly associated with an increased CVR. There is a trend towards an increased prevalence of hypercholesterolemia and hypertension paralleling the aging.
Conclusions
Using the FRAM scores, the median CVR of developing a cardiac event at 10 years in a population of Spanish HIV-1-infected inmate males is 5.88%. Of them, 5.1% have a high CVR, and are evenly distributed among age groups. The smoking prevalence is significantly higher than in non-inmate HIV-1 infected individuals, and is so high that it does not allow CVR differences among age groups. HCV-coinfection, cocaine use, and parenteral cocaine consumption were not associated with an increased CVR in our population. On the other hand, a lower nadir CD4 count was associated with high rates of CVR, thus supporting an earlier initiation of ARV therapy in HIV-1 infected males in the prison environment.
This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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