Cited by 432HIV-related health complications and treatmentsHIV/AIDS Research and InterventionsHIV/AIDS drug development and treatment

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Relative risk of cardiovascular disease among people living with HIV : a systematic review and meta‐analysis

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Islam, FM, Wu, J, Jansson, J, Wilson, DP·2012·HIV Medicine

DOI 10.1111/j.1468-1293.2012.00996.x

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Abstract

Objectives: The aim of this study was to estimate the relative risk of cardiovascular disease ( CVD ) among people living with HIV ( PLHIV ) compared with the HIV ‐uninfected population. Methods: We conducted a systematic review and meta‐analysis of studies from the peer‐reviewed literature. We searched the M edline database for relevant journal articles published before A ugust 2010. Eligible studies were observational and randomized controlled trials, reporting CVD , defined as myocardial infarction ( MI ), ischaemic heart disease, cardiovascular and cerebrovascular events or coronary heart disease among HIV ‐positive adults. Pooled relative risks were calculated for various groupings, including different classes of antiretroviral therapy ( ART ). Results: The relative risk of CVD was 1.61 [95% confidence interval ( CI ) 1.43–1.81] among PLHIV without ART compared with HIV ‐uninfected people. The relative risk of CVD was 2.00 (95% CI 1.70–2.37) among PLHIV on ART compared with HIV ‐uninfected people and 1.52 (95% CI 1.35–1.70) compared with treatment‐naïve PLHIV . We estimate the relative risk of CVD associated with protease inhibitor ( PI )‐, nucleoside reverse transcriptase inhibitor‐ and nonnucleoside reverse transcriptase inhibitor‐based ART to be 1.11 (95% CI 1.05–1.17), 1.05 (95% CI 1.01–1.10) and 1.04 (95% CI 0.99–1.09) per year of exposure, respectively. Not all ART was associated with increased risk; specifically, lopinavir/ritonavir and abacavir were associated with the greater risk and the relative risk of MI for PI ‐based versus non‐ PI ‐based ART was 1.41 (95% CI 1.20–1.65). Conclusion: PLHIV are at increased risk of cardiovascular disease. Although effective in prolonging survival, ART (in particular PI ‐based regimens) is related to further increased risk of CVD events among people at highest initial absolute risk of cardiovascular disease.

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Mapesi, H., Gupta, R., Wilson, H. I., Lukau, B., Amstutz, A., Lyimo, A., Muhairwe, J., Senkoro, E., Byakuzana, T., Mphunyane, M., et al. (2021) · Trials · doi:10.1186/s13063-021-05023-z · Cited by 8
Changes in blood lipid levels and influencing factors among treatment-naïve adult male HIV/AIDS patients following BIC/FTC/TAF vs. 3TC+EFV+TDF
Wang, X., Liu, A., Li, Z., Zhang, H., Wu, R. E., Shao, Y., Li, J., Ye, J., Liu, W., & Sun, L. (2024) · Chinese Medical Journal · doi:10.1097/cm9.0000000000003147 · Cited by 7
“[7] In China, most HIV/AIDS patients on ART primarily receive non-nucleoside reverse transcriptase inhibitors (NNRTIs) such as efavirenz (EFV), nevirapine (NVP), and protease inhibitors (PIs), with only a minority being treated with integrase strand transfer inhibitors (INSTIs).”
Background
Beginning Antiretroviral Therapy for Patients with HIV
Johnson, J. A., & Sax, P. E. (2014) · Infectious Disease Clinics of North America · doi:10.1016/j.idc.2014.06.003 · Cited by 7
Elevated Microparticle Tissue Factor Activity Is Associated With Carotid Artery Plaque in HIV-Infected Women
Lin, J., Xue, X., Anastos, K., Cohen, M. H., Gange, S. J., Lazar, J., Liu, C., Mack, W. J., Tien, P. C., Tilley, C., et al. (2019) · JAIDS Journal of Acquired Immune Deficiency Syndromes · doi:10.1097/qai.0000000000001988 · Cited by 7
Association Between the Framingham Risk Score and Carotid Artery Intima-Media Thickness in Patients With Human Immunodeficiency Virus
Ngamdu, K. S., Adewale, O. O., Mallawaarachchi, I. V., Alozie, O. K., Dwivedi, A. K., & Bhatt, D. L. (2020) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2020.04.019 · Cited by 7
The benefits of tenofovir discontinuation with or without bisphosphonate therapy in osteoporotic people living with HIV
Lei, J. J. H., Pereira, B. I., Moyle, G. J., Boffito, M., & Milinkovic, A. (2021) · HIV Medicine · doi:10.1111/hiv.13137 · Cited by 7
“Although an alternative option for TDF switch is abacavir, this has also been associated with increased cardiovascular risk [47].”
Background
Earlier antiretroviral initiation is independently associated with better arterial stiffness in children living with perinatally acquired HIV with sustained viral suppression in Mozambique
Dobe, I., Mocumbi, A. O., Majid, N., Ayele, B. T., Browne, S. H., & Innes, S. (2021) · Southern African Journal of HIV Medicine · doi:10.4102/sajhivmed.v22i1.1282 · Cited by 7
HOPX Plays a Critical Role in Antiretroviral Drugs Induced Epigenetic Modification and Cardiac Hypertrophy
Kashyap, S., Rabbani, M., de Lima, I. B., Kondrachuk, O., Patel, R., Shafiei, M. S., Mukker, A., Rajakumar, A., & Gupta, M. (2021) · Cells · doi:10.3390/cells10123458 · Cited by 7
“The relative risk of various CVDs in HIV patients has tripled since HIV was first reported, with a 61% increase in relative risk of CVDs, such as ischemic stroke, heart failure (HF), pulmonary hypertension, myocardial infarction, and venous thrombosis [7].”
Background
Implementing screening for hypertension in archetypal HIV primary care: a mixed-methods assessment
Buzaalirwa, L., Nambala, L., Banturaki, G., Amor, P. I., Katahoire, A., Geng, E. H., & Semeere, A. (2022) · BMC Health Services Research · doi:10.1186/s12913-022-08362-y · Cited by 7
The Economic Burden of HIV/AIDS and Myocardial Infarction Treatment in Brazil
Araújo, D. V., Bahia, L., & Stella, S. F. (2013) · The Scientific World JOURNAL · doi:10.1155/2013/864962 · Cited by 7
Genetic polymorphisms in the CD14 gene are associated with monocyte activation and carotid intima-media thickness in HIV-infected patients on antiretroviral therapy
Yong, Y. K., Shankar, E. M., Westhorpe, C. L. V., Maisa, A., Spelman, T. D., Kamarulzaman, A., Crowe, S. M., & Lewin, S. R. (2016) · Medicine · doi:10.1097/md.0000000000004477 · Cited by 7
The spectrum of heart disease in adults in Malawi: A review of the literature with reference to the importance of echocardiography as a diagnostic modality
Allain, T. J., Kinley, L., Tsidya, B., Murray, A., Cheesman, M., Kampondeni, S., & Kayange, N. (2016) · Malawi Medical Journal · doi:10.4314/mmj.v28i2.7 · Cited by 7
Short Communication: Predictive Value of HIV-Related Versus Traditional Risk Factors for Coronary Atherosclerosis in People Aging with HIV
Pereira, B. I., Mazzitelli, M., Milinkovic, A., Moyle, G., Mandalia, S., Al-hussaini, A., & Boffito, M. (2021) · AIDS Research and Human Retroviruses · doi:10.1089/aid.2021.0064 · Cited by 8
A pilot cross-sectional study of non-communicable diseases in TB household contacts
Hamada, Y., Lugendo, A., Ntshiqa, T., Kubeka, G., Lalashowi, J., Mwastaula, S., Ntshamane, K., Sabi, I., Wilson, S., Copas, A. J., et al. (2024) · IJTLD OPEN · doi:10.5588/ijtldopen.23.0579 · Cited by 6
“30 The risk may be heightened by HIV co-infection 31 and by TB. 32 The WHO recommends assessment of CVD risk in individuals at risk for CVD, such as people aged .”
Cardiometabolic Characteristics of Obesity Phenotypes in Persons With HIV
Swartz, A. Z., Robles, M. E., Park, S., Esfandiari, H., Bradshaw, M. L., Koethe, J. R., & Silver, H. J. (2024) · Open Forum Infectious Diseases · doi:10.1093/ofid/ofae376 · Cited by 6
Subclinical Myocardial Fibrosis in South African Youth With HIV: Results From the CTAAC-Heart Study
Jao, J. K., Zar, H. J., Kahts, M., Jermy, S., Egan, D. J. S., Nyathi, M. N., Asafu‐Agyei, N. A., Legbedze, J., Carkeek, E., Jele, N., et al. (2024) · Open Forum Infectious Diseases · doi:10.1093/ofid/ofae555 · Cited by 6
Leveraging routine viral load testing to integrate diabetes screening among patients on antiretroviral therapy in Malawi
Singano, V., van Oosterhout, J. J., Gondwe, A., Nkhoma, P., Cataldo, F., Singogo, E., Theu, J., Ching’ani, W., Hosseinpour, M. C., & Amberbir, A. (2020) · International Health · doi:10.1093/inthealth/ihaa030 · Cited by 6
“10,20,21 While diabetes is associated with vascular morbidity and mortality, and this is important in populations on ART who live longer with chronic morbidities and have increased CVD risk, the low diabetes prevalence does not seem to justify screening all ART patients annually, given the current annual frequency of…”
Background
Comparison of Predicted Cardiovascular Risk Profiles by Different CVD Risk-Scoring Algorithms between HIV-1-Infected and Uninfected Adults: A Cross-Sectional Study in Tanzania
Msoka, T. F., Rogath, J., Guilder, G. P. V., Kapanda, G., Smulders, Y. M., van Furth, A. M., Bartlett, J. A., & van Agtmael, M. A. (2021) · HIV/AIDS - Research and Palliative Care · doi:10.2147/hiv.s304982 · Cited by 6
“Multiple studies have compared calculated risk between HIV-infected persons (both with and without ART) and controls and found conflicting results; some studies suggesting a similar risk,(7,8) others an increased risk due to chronic inflammation of the HIV-infection.(9,10) Some studies related this increased CVD risk…”
Result
The Role of Age in Subclinical Atherosclerosis in Asian People Living with Human Immunodeficiency Virus
Park, S., Park, S. Y., Lee, E. J., Kim, T. H., & Lee, E. (2022) · Infection and Chemotherapy · doi:10.3947/ic.2022.0033 · Cited by 6
“While traditional risk factors such as smoking and obesity may coexist, HIV itself is an independent risk factor for CVD among PLHIV [4, 5].”
Background
Trained immunity: A link between risk factors and cardiovascular disease
Chen, M., Kang, X., Zhang, Y., & Liu, Y. (2024) · British Journal of Pharmacology · doi:10.1111/bph.16472 · Cited by 8
“Chronic infections caused by specific micro-organisms such as cytomegalovirus and HIV, have also been linked to atherosclerosis cardiovascular disease (Islam et al., 2012; Leentjens et al., 2018; Wang et al., 2017).”
Nitric oxide levels in HIV-infected, untreated patients and HIV-infected patients receiving antiretroviral therapy
Soccal, R. M., de Carvalho, J. A. M., Bochi, G. V., Moresco, R. N., & da Silva, J. É. P. (2016) · Biomedicine & Pharmacotherapy · doi:10.1016/j.biopha.2016.02.027 · Cited by 6
“found that the risk of cardiovascular disease for patients on HAART was twice as great as the risk for untreated patients [29].”
Greater remnant lipoprotein cholesterol reduction with pitavastatin compared with pravastatin in HIV-infected patients
Joshi, P. H., Miller, P. E., Martin, S. S., Jones, S. R., Massaro, J. M., D’Agostino, R. B., Kulkarni, K. R., Sponseller, C. A., & Toth, P. P. (2017) · AIDS · doi:10.1097/qad.0000000000001423 · Cited by 6
“One meta-analysis found a two-fold higher risk for CVD among ART-treated HIV infected participants compared with those without HIV [24].”
Result
Impact of Patient–Provider Attachment on Hospital Readmissions Among People Living With HIV: A Population-Based Study
Parent, S., Barrios, R., Nosyk, B., Ye, M., Bacani, N., Panagiotoglou, D., Montaner, J. S. G., Ti, L., & on behalf of the STOP HIV/AIDS in BC Study Group (2018) · JAIDS Journal of Acquired Immune Deficiency Syndromes · doi:10.1097/qai.0000000000001857 · Cited by 6
Improving Quality of Care for Hospitalized Smokers with HIV: Tobacco Dependence Treatment Referral and Utilization
Fitzgerald, S., Richter, K. P., Mussulman, L. M., Howser, E., Nahvi, S., Goggin, K., Cooperman, N. A., & Faseru, B. (2016) · The Joint Commission Journal on Quality and Patient Safety · doi:10.1016/s1553-7250(16)42028-3 · Cited by 6
Resting Autonomic Function in Active and Insufficiently Active People Living with HIV
Quiles, N. N., Garber, C. E., & Ciccolo, J. T. (2017) · International Journal of Sports Medicine · doi:10.1055/s-0043-118033 · Cited by 6
Role of toll-like receptor 4 Asp299Gly polymorphism in the development of cardiovascular diseases in HIV-infected patients
Tarancón‐Díez, L., Pablo-Bernal, R. S. D., Jiménez, J. L., Álvarez‐Ríos, A. I., Genebat, M., Rosado‐Sánchez, I., Muñoz‐Fernández, M. Á., Ruíz-Mateos, E., & Leal, M. (2018) · AIDS · doi:10.1097/qad.0000000000001797 · Cited by 6
Hypertension and one-year risk of all-cause mortality among women with treated HIV in the United States
Sadinski, L. M., Westreich, D., Edmonds, A., Breger, T., Cole, S., Ramirez, C., Brown, T., Ofotokun, I., Konkle-Parker, D., Kassaye, S. G., et al. (2022) · AIDS (London) · doi:10.1097/qad.0000000000003461 · Cited by 3
Differential Adipose Tissue Gene Expression Profiles in Abacavir Treated Patients That May Contribute to the Understanding of Cardiovascular Risk: A Microarray Study
Shahmanesh, M., Phillips, K. L., Boothby, M., & Tomlinson, J. (2015) · PLoS ONE · doi:10.1371/journal.pone.0117164 · Cited by 5
Effectiveness of an 8-Week Aerobic Exercise Program on Autonomic Function in People Living with HIV Taking Anti-Retroviral Therapy: A Pilot Randomized Controlled Trial
Quiles, N. N., Taylor, B. S., & Ortíz, A. (2019) · AIDS Research and Human Retroviruses · doi:10.1089/aid.2019.0194 · Cited by 5
“4 Regular aerobic exercise is known to be effective for improving autonomic function in apparently healthy individuals.”
Influence of Human Immunodeficiency Virus Infection on the Management and Outcomes of Acute Myocardial Infarction With Cardiogenic Shock
Vallabhajosyula, S., Subramaniam, A. V., Sundaragiri, P. R., Cheungpasitporn, W., Temesgen, Z., O’Horo, J. C., Jaffe, A. S., & Barsness, G. W. (2020) · JAIDS Journal of Acquired Immune Deficiency Syndromes · doi:10.1097/qai.0000000000002442 · Cited by 5
Cardiovascular risk in HIV-infected individuals: A comparison of three risk prediction algorithms
Policarpo, S., Rodrigues, T., Moreira, A. C., & Valadas, E. (2019) · Revista Portuguesa de Cardiologia (English Edition) · doi:10.1016/j.repce.2018.10.012 · Cited by 5
Influence of physical activity on endothelial function in people living with HIV
Preveden, A., Čolović, P., Garipi, E., Bogdan, M., Preveden, M., Marić, D., Brkic, S. V., & Barak, O. F. (2023) · HIV Medicine · doi:10.1111/hiv.13533 · Cited by 5
Rate of cardiovascular, renal and bone disease and their major risks factors in HIV-infected individuals on antiretroviral therapy in Spain
Knobel, H., Domingo, P., Suárez-Lozano, I., Gutiérrez, F., Estrada, V., Palacios, R., Antela, A., Blanco, J. R., Fulladosa, X., & Refollo, E. (2019) · Enfermedades infecciosas y microbiologia clinica (English ed ) · doi:10.1016/j.eimce.2018.09.005 · Cited by 5
Developing an Action Model for Integration of Health System Response to HIV/AIDS and Noncommunicable Diseases (NCDs) in Developing Countries
Haregu, T., Setswe, G., Elliott, J., & Oldenburg, B. F. (2013) · Global Journal of Health Science · doi:10.5539/gjhs.v6n1p9 · Cited by 5
Sex differences in the contemporary management of HIV patients admitted for acute myocardial infarction
Ogunbayo, G. O., Bidwell, K., Misumida, N., Ha, L. D., Abdel‐Latif, A., Elayi, C. S., Smyth, S. S., & Messerli, A. W. (2018) · Clinical Cardiology · doi:10.1002/clc.22902 · Cited by 5
“00 (depending on treatment status) as compared with seronegative controls.(9) Females with HIV have been associated with young age and a higher prevalence of both HTN and DM as compared with men with HIV.”
Aortic Pressure Levels and Waveform Indexes in People Living With Human Immunodeficiency Virus: Impact of Calibration Method on the Differences With Respect to Non-HIV Subjects and Optimal Values
Díaz, A., Grand, M., Torrado, J., Salazar, F., Zócalo, Y., & Bia, D. (2021) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2021.772912 · Cited by 4
Cardiovascular Risk Prediction Equations Underestimate Risk in People Living with HIV: Comparison and Cut-point Redefinition for 19 Cardiovascular Risk Equations
Grand, M., Díaz, A., & Bia, D. (2022) · Current HIV Research · doi:10.2174/1570162x20666220126124149 · Cited by 6
Longitudinal association between cardiometabolic comorbidities and physical activity in middle aged and older adults living with HIV
Quiles, N. N., Balachandran, A. T., & Ortíz, A. (2022) · Experimental Gerontology · doi:10.1016/j.exger.2022.111797 · Cited by 4
Risk of Myocardial Infarction in HIV Patients: A Systematic Review
Alsheikh, M. M., & Alsheikh, A. M. (2022) · Cureus · doi:10.7759/cureus.31825 · Cited by 4
Electrocardiographic abnormalities and associated factors among HIV-infected adults on antiretroviral therapy
Befkadu, Z., Ibrahim, M., Tadelle, A., & Tegene, E. (2024) · Frontiers in Reproductive Health · doi:10.3389/frph.2024.1387464 · Cited by 4
HIV-associated Extracranial Arterial Aneurysms: A Systematic Review
Kariyanna, P. T., Yager, J. E., Salciccioli, L. F., Lazar, J., Polman, D., Chandrakumar, H. P., & McFarlane, I. M. (2020) · American Journal of Medical Case Reports · doi:10.12691/ajmcr-8-5-5 · Cited by 4
“HIV patients on HAART had a higher CVD risk compared to HIV patients not receiving HAART [1].”
BackgroundInfluential
24-hour ambulatory blood pressure monitoring and hypertension related risk among HIV-positive and HIV-negative individuals: cross sectional study findings from rural Uganda
Niwaha, A. J., Wosu, A. C., Namugenyi, C., Kayongo, A., Nyirenda, M., Siddharthan, T., Checkley, W., Semitala, F. C., & Kalyesubula, R. (2021) · Journal of Human Hypertension · doi:10.1038/s41371-020-00464-6 · Cited by 4
“The potential mechanisms for the increased CVD risk among PLHIV include high prevalence of traditional CVD risk factors like high blood pressure (hypertension), smoking and dyslipidaemia (7), cumulative exposure to ART leading to metabolic derangements (side effects) (8, 9), as well as continuing low grade chronic inf…”
Background
HIV-1 Infection Promotes Cholesterol Aggregation by Inducing miR-33b-5p to Suppress ABCA1 Expression
You, Q., Qiao, J., Peng, Q., Li, W., Li, J., Hu, S., Shu, Z., & Sun, B. (2023) · AIDS Research and Human Retroviruses · doi:10.1089/aid.2022.0152 · Cited by 6
Metabolic events in HIV-infected patients using abacavir are associated with erythrocyte inosine triphosphatase activity
Peltenburg, N. C., Bierau, J., Schippers, J. A., Lowe, S. H., Paulussen, A. D. C., van den Bosch, B. J. C., Leers, M. P. G., Andrinopoulou, E., Bakker, J. A., & Verbon, A. (2018) · Journal of Antimicrobial Chemotherapy · doi:10.1093/jac/dky383 · Cited by 4
Management of cardiovascular diseases in HIV/AIDS patients
Ashwitha, S. K., Jacob, P. A., Ajaj, A., Shirke, M., & Harky, A. (2020) · Journal of Cardiac Surgery · doi:10.1111/jocs.15213 · Cited by 4
“In the study, they demonstrated that these risk factors such as increasing age, smoking, diabetes, dyslipidemia, and male sex were all factors that contribute significantly in those with HIV to CVD predicted risk over 5 years.(29) This is highlighted in Table 2, displaying different subgroups of the risk factors for C…”
Background
L’infection par le VIH : une maladie chronique redéfinissant la collaboration entre généralistes et spécialistes. Obstacles et opportunités
Belche, J. L., Kang, T., Ketterer, F., Berrewaerts, M.-A., Moutschen, M. P., & Giet, D. (2015) · Santé Publique · doi:10.3917/spub.153.0373 · Cited by 4
HIV and Aging: Parallels and Synergistic Mechanisms Leading to Premature Disease and Functional Decline
Hearps, A. C., Schafer, K. R., High, K. P., & LANDAY, A. L. (2015) · Springer eBooks · doi:10.1007/978-3-319-23246-1_17 · Cited by 5
Porphyromonas gingivalis antibody levels and diagnosis of coronary artery disease in HIV ‐positive individuals
Berquist, V., Hearps, A. C., Ford, P. J., Jaworowski, A., Leishman, S. J., Hoy, J., & Trevillyan, J. M. (2017) · Journal of Periodontal Research · doi:10.1111/jre.12460 · Cited by 4
Incidence and risk factors regarding atherosclerotic cardiovascular disease in middle-aged and elderly people with HIV treated in Chongqing, China
Liu, M., Li, M., Liu, Q., Fu, Y., Wu, Y., Huang, R., Cao, Q., & Yang, H. (2024) · AIDS Research and Therapy · doi:10.1186/s12981-024-00684-7 · Cited by 3

Authors: Islam, F., Wu, J., Jansson, J., & Wilson, D.
Affiliations: The Kirby Institute Faculty of Medicine University of New South Wales Sydney NSW Australia
UNSW Sydney (AU)
Corresponding author: Wilson, DP
ORCID: Wu, J
Jansson, J
Venue: HIV Medicine
Publisher: Wiley
Published: 2012-03-14
Volume: 13
Issue: 8
Pages: 453-468
ISSN: 1464-2662 (ISSN-L)
1468-1293
DOI: 10.1111/j.1468-1293.2012.00996.x
OpenAlex: W1677033108
Cited by: 432
References: 40
Citations by year: 2026: 13 · 2025: 16 · 2024: 28 · 2023: 19 · 2022: 31 · 2021: 39 · 2020: 42 · 2019: 28 · 2018: 44 · 2017: 34 · 2016: 40 · 2015: 29 · 2014: 27 · 2013: 26 · 2012: 15
FWCI: 6.87
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations: HIV Medicine (publishedVersion)
PubMed (publishedVersion)
Funders: Australian Government
Medical Research Council
Australian Research Council (DP1093026, FT0991990)
National Health and Medical Research Council (630495)
Topics: Health Sciences › Medicine › Infectious Diseases › HIV-related health complications and treatments
Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
Health Sciences › Medicine › Infectious Diseases › HIV/AIDS drug development and treatment
Keywords: cardiovascular disease, people living with HIV, antiretroviral therapy, protease inhibitors, myocardial infarction, ischemic heart disease, coronary artery disease, cerebrovascular events, lopinavir/ritonavir, abacavir, cardiovascular risk
MeSH terms: Adult, Cardiovascular Diseases, Humans, Protease Inhibitors, Risk Factors, HIV Infections, Incidence, Reverse Transcriptase Inhibitors, Anti-Retroviral Agents

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Relative risk of cardiovascular disease among people living with HIV : a systematic review and meta‐analysis

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