Background
Methods
Search strategy
Study selection
Data extraction
Results
Study selection
CVD risk factors
CVD outcomes
Surrogate CVD outcomes
Study (location, dates) | Study Design | N = | Age (years)a
| ART-status | Findings |
---|---|---|---|---|---|
Fourie et al. [93] (SA, 2005) | Case-control | PLWH: 300 HIV-: 300 | 44 ± 8 44 ± 8 | 100% ART-naïve | • Untreated HIV associated with higher biomarkers of endothelial injury |
Lazar et al. [92] (Rwanda, 2005) | Prospective cohort | PLWH: 276 HIV-: 67 | 35 ± 7 41 ± 10 | 59% ART-naïve 41% on ART | • HIV not associated with increased arterial wave reflection |
Botha et al. [132] (SA, 2005-10) | Prospective cohort | PLWH: 137 | no ART: 47.6 ± 1.9 on ART: 47.8 ± 1.6 | 52% ART-naïve 48% on ART | • ART exposure associated with higher pulse pressure |
Fourie et al. [78] (SA, 2005-10) | Prospective cohort | PLWH: 144 HIV-: 165 | no ART: 48 ± 1 on ART: 49 ± 1 50 ± 1 | 54% ART-naïve 46% on ART | • >5y HIV infection associated with increased biomarkers of endothelial activation |
Ngatchou et al. [94] (Cameroon, 2009-10) | Cross-sectional | PLWH: 108 HIV-: 96 | 39 ± 11 41 ± 12 | 100% ART-naïve | • HIV associated with aortic stiffness as assessed by radial tonometry |
Ngatchou et al. [133] (Cameroon, 2009-10) | Cross-sectional | PLWH: 238 | no ART: 39 ± 11 on ART: 41 ± 12 | 45% ART-naïve 55% on ART | • ART exposure associated with increased pulse pressure and augmentation index among ART-experienced patients compared to untreated PLWH |
Ssinabulya et al. [95] (Uganda, 2012) | Cross-sectional | PLWH: 245 | 37 (31-37) | 59% ART-naïve 41% on ART | • HIV associated with 18% risk of pre-clinical carotid atherosclerosis on ultrasound imaging |
Awotedu et al. [96] (SA, 2012-13) | Cross-sectional | PLWH: 106 HIV-: 63 | no ART: 36 ± 11 on ART: 40 ± 10 36 ± 11 | 51% ART-naïve 49% on ART | • HIV associated with increased aortic pulse wave velocity • Highest increase among ART-experienced |
Schoffelen et al. [99] (SA, 2013) | Cross-sectional | PLWH: 904 | 41 (35-48) | 13% ART-naïve 87% on ART | • cIMT associated with traditional CVD risk factors, not HIV-specific factors |
Siedner et al. [97] (Uganda, 2013-14) | Cross-sectional | PLWH: 105 HIV-: 100 | 49 (45-51) 50 (46-54) | 100% on ART | • HIV associated with twice the risk of arterial stiffness as assessed by calculating ankle-brachial index |
Feinstein et al. [98] (Uganda, not stated) | Cross-sectional | PLWH: 105 HIV-: 100 | 49 ± 6 52 ± 9 | 100% on ART | • HIV not associated with carotid intima media thickness |
Gleason et al. [81] (Ethiopia, not stated) | Cross-sectional | PLWH: 281 HIV-: 36 | no ART: 38 (32-45) EFV: 38 (32-45) LPV/r: 39 (35-44) NVP: 37 (32-42) 39 (29-45) | 18% ART-naïve 82% on ART | • Use of EFV & LPV/r, nut not NVP, is associated with elevated pulse wave velocity, normalized cIMT, and abnormal FMD |
Mosepele et al. [91] (Botswana, not stated) | Cross-sectional | PLWH: 208 | 39 (5) | 25% ART-naïve 75% on ART | • Atherosclerotic CVD risk score and cIMT measurement similarly identify high CVD risk |
Acute coronary syndrome
Study (location, dates) | Study Design | N = | Age (years)a
| ART-status | Findings |
---|---|---|---|---|---|
Becker et al. [101] (SA, 2004-08) | Prospective case-control | ACS + PLWH: 30 ACS + HIV-: 30 | 43 ± 7 54 ± 13 | 100% ART-naïve | • Traditional risk factors more prevalent in HIV-, except for smoking • PLWH more likely to have single vessel disease and greater thrombus burden • PLWH more likely to have MACE and need TLR at follow-up |
Becker et al. [103] (SA, 2004-08) | Same study population as above | • PLWH with ACS more likely to have lower protein C and higher Factor VIII, Anti-cardiolipin IgG and Anti-prothrombin IgG | |||
Becker et al. [104] (SA, 2004-08) | Prospective case-control | ACS-PLWH: 30 ACS + PLWH: 30 ACS + HIV-: 30 | 41 ± 8 43 ± 7 54 ± 13 | 100% ART-naïve | • PLWH are more likely to have anti-phospholipid antibodies but this is not associated with ACS |
Sliwa et al. [24] (SA, 2006-08) | Cohort | PLWH: 518 | 39 ± 13 | 46% ART-naïve 54% on ART | • 170 (32.8%) were new HIV diagnoses • 14 (2.7%) were admitted with ACS and 18 (3.5%) with cerebrovascular disease |
Redman et al. [105] (SA, 2008-11) | Prospective cohort of vascular surgery patients | PLWH: 73 HIV-: 152 | 41 ± 10 56 ± 13 | 68% ART-naïve 23% on ART | • Lower RCRI score among PLWH • No difference in 30 day outcomes (13% vs 15%), even though PLWH were younger |
Stroke
Study (location, dates) | Study Design | N = | Age (years)a
| ART-status | Findings |
---|---|---|---|---|---|
Study population: stroke patients | |||||
Patel et al. [116] (SA, 1987-2002) | Retrospective case-controlb
| PLWH: 56 HIV-: 154 | 15-44 | 100% ART-naïve | • No significant differences between PLWH and HIV- patients with stroke regarding cardiac etiologies or angiography |
Hoffmann et al. [117] (SA, 1992-98) | Prospective case-controlb
| PLWH: 22 HIV-: 23 | 29.1 (20-42) 31.0 (19-44) | 100% ART-naïve | • PLWH with fewer traditional CVD risk factors • 20 of 22 (91%) PLWH with unknown etiology for stroke • All PLWH were diagnosed with HIV at admission for stroke |
Mochan et al. [114] (SA, 1999-2000) | Case series of PLWH and stroke | PLWH: 35 | 32.1 (20-61) | 100% ART-naïve | • 94% ischemic; 6% hemorrhagic • LP showed infection in 10 of 33 PLWH • 17 PLWH had coagulopathy |
Tipping et al. [113] (SA, 2000-06) | Prospective cohort of stroke patients | PLWH: 67 HIV-: 1020 (all subjects)
PLWH: 61 HIV-: 205 (<46y)
| 33.4 (19-76) 64 (17-96) | 12% < 6 months ART 88% ART-naïve | • 96% ischemic; 4% hemorrhagic • ID etiologies predominant among PLWH (37% vs 8%) • 20% of PLWH had HIV vasculopathy • Fewer traditional risk factors among PLWH <46 years |
Kumwenda et al. [112] (Malawi, 2001-02) | Prospective case-control | PLWH: 47 HIV-: 51 | 37.5 ± 13.1 58.6 ± 16.8 | 100% ART-naïve | • 11 (23%) of PLWH diagnosed with infectious etiologies of stroke |
Heikinheimo et al. [115] (Malawi, 2008-09) | Cohort of 1st time stroke | PLWH: 50 HIV-: 84 | 39.8 ± 12.4 61.9 ± 14.0 | 22% on ART | • No difference in outcomes between PLWH and HIV- • PLWH were younger with fewer CVD risk factors |
Owolabi et al. [37] (Nigeria, 2008-10) | Prospective cohort of stroke patients (18-40 years) | PLWH: 6 HIV-: 65 | 31.9 ± 6 | Not stated | • 8.5% were PLWH but not all patients were tested • HIV is 5th most common risk factor |
Study population: PLWH | |||||
Longo-Mbenza et al. [134] (DRC, 2004-08) | Cross-sectional | PLWH: 116 | 45.3 ± 8.5 (men) 42.5 ± 11.2 (women) | 100% of stroke patients on ART | • 17 (15%) PLWH had stroke • 94% ischemic; 6% ICH • Uncertain ID workup • Fewer traditional risk factors among stroke patients, but lower CD4 and more WHO Stage 3-4 |
Divala et al. [135] (Malawi, 2014) | Cross-sectional | PLWH: 952 | 43.0 ± 10.2 | 4.1% ART-naïve 95.9% on ART | • Self-reported past stroke: 4.3% |
Study population: stroke (cases) and non-stroke from community (controls) | |||||
Walker et al. [118] (Tanzania, 2003-06) | Case-controlb
| Stroke: 201 (PLWH: 25) Controls: 398 (PLWH: 15) | 61.7 (15.0) and 68.8 (14.8)c
61.4 (13.1) and 69.4 (14.6)c
| 100% ART-naïve | • Stroke associated with traditional risk factors • HIV independently associated with stroke (aOR, 5.61) |
Benjamin et al. [136] (Malawi, 2011-12) | Case-controld
| Stroke: 222 (PLWH: 69) Controls: 503 (PLWH: 95) | 60 (42-70) 57 (42-67) | 17% ART-naïve 7% ART <6 mo 6% ART ≥6 mo 9% ART-naïve 1% ART <6 mo 8% ART ≥6 mo | • 78% ischemic; 22% hemorrhagic • Stroke associated with HIV (aOR, 3.28), especially if ART started in past 6 months (aOR, 15.6) • No effect modification for HIV and HTN • Diabetes and smoking were independently associated |
Asiki et al. [137] (Uganda, not stated) | Retrospective case-controlb
| Stroke: 31 (PLWH: 5) Controls: 135 (PLWH: 8) | 59.0 (13.7) 60.2 (13.7) | 62% of PLWH are ART-naïve | • Increased risk of stroke among HIV+ (16% vs 6%) • Potentially biased sample given patients included only if they had frozen specimen available for varicella IgG testing |
Mochan et al. [138] (SA, not stated) | Case-controle
| Stroke: 33 (PLWH: 33) Controls: 66 (PLWH: 33) | 32.1 (20-61) | Not stated | • Protein S deficiency associated with HIV, not stroke |