COVID-19 infection ups CV risk in people living with HIV

People living with HIV (PLWH) who were diagnosed with COVID-19 had a 35-percent higher risk of a major cardiovascular (CV) event in the following year than PLWH without COVID in a Spanish study.

“This suggests that COVID-19 in PLWH should be considered as an additional CV risk factor in the short term,” said study author Dr Raquel Martin-Iguacel, consultant physician in Infectious Diseases at the Odense University Hospital in Odense, Denmark, who presented at EACS 2023.

The difference in risk was evident for thrombosis, heart failure (HF), and aneurysms.  However, PLWH with COVID-19 had no increased rates of heart attack or stroke.

Previous studies have shown that unvaccinated people with HIV have a higher risk of hospitalization and death from COVID-19, but the risk of new CV events after a COVID-19 diagnosis has not been studied in PWH.

“This is particularly important as PLWH have increased CV risks due to the HIV itself, dyslipidaemia caused by antiretroviral treatment, and lifestyle factors, such as smoking and obesity,” said Martin-Iguacel.

She and her team reviewed COVID-19 diagnoses among 18,203 PLWH in the PISCIS HIV cohort, 4,199 of whom were diagnosed with COVID-19 during the study period from March 2020 to July 2022. [EACS 2023, abstract PS3.01]

Demographic and HIV characteristics were broadly similar between the two groups: 82 percent of the participants were male, 90 percent had an undetectable viral load, and 97 percent had a CD4 count ≥200 cells/µL at the time of COVID-19 diagnosis (or at baseline, for patients who had no COVID-19). The median age was 45 years in the COVID group and 49 years in the non-COVID group.

Within the COVID-19 group, 13 percent contracted the respiratory virus more than once, 8 percent were hospitalized for one day or longer, and 0.6 percent were admitted to the intensive care unit.

CV events analysed included dysrhythmia, cerebrovascular disease, ischaemic heart disease, thrombotic disorders, HF, inflammatory heart disease, peripheral vascular disease, aneurysms, and cardiac arrest.

Overall, 1.6 percent of participants experienced ischaemic heart disease during the study period. Additionally, 1 percent had HF and 0.9 percent suffered from cerebrovascular events. Thrombotic disorders, HF, and other cardiac disorders were significantly more common among PLWH who had COVID-19 than those who had not.

The incidence rate for all CV events was 70.2 per 1,000 person-years among participants with COVID-19 vs 56.8 per 1,000 person-years among participants who were not diagnosed with COVID-19. Those with COVID-19 had a 35 percent higher CV event risk within the first year after their COVID-19 diagnosis. “The higher risk was especially pronounced in the first 6 months after contracting the respiratory virus,” said Martin-Iguacel.

Previous cardiovascular disease, chronic kidney or liver disease, older age, and being a heterosexual man were also associated with an increased risk for CV events.

“Among PLWH recovering from COVID-19, CV health needs to be a focus of care,” said Martin-Iguacel.  “Full vaccination against COVID-19 and keeping up to date with booster doses is also crucial for this population already at increased risk for heart disease.”