Global Burden of Atherosclerotic Cardiovascular Disease in People Living With HIV: Systematic Review and Meta-Analysis
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Background: With advances in antiretroviral therapy, most deaths in people with HIV are now attributable to noncommunicable illnesses, especially cardiovascular disease. We determine the association between HIV and cardiovascular disease, and estimate the national, regional, and global burden of cardiovascular disease attributable to HIV. Methods: We conducted a systematic review across 5 databases from inception to August 2016 for longitudinal studies of cardiovascular disease in HIV infection. A random-effects meta-analysis across 80 studies was used to derive the pooled rate and risk of cardiovascular disease in people living with HIV. We then estimated the temporal changes in the population-attributable fraction and disability-adjusted life-years (DALYs) from HIV-associated cardiovascular disease from 1990 to 2015 at a regional and global level. National cardiovascular DALYs associated with HIV for 2015 were derived for 154 of the 193 United Nations member states. The main outcome measure was the pooled estimate of the rate and risk of cardiovascular disease in people living with HIV and the national, regional, and global estimates of DALYs from cardiovascular disease associated with HIV. Results: In 793 635 people living with HIV and a total follow-up of 3.5 million person-years, the crude rate of cardiovascular disease was 61.8 (95% CI, 45.8–83.4) per 10 000 person-years. In comparison with individuals without HIV, the risk ratio for cardiovascular disease was 2.16 (95% CI, 1.68–2.77). Over the past 26 years, the global population–attributable fraction from cardiovascular disease attributable to HIV increased from 0.36% (95% CI, 0.21%–0.56%) to 0.92% (95% CI, 0.55%–1.41%), and DALYs increased from 0.74 (95% CI, 0.44–1.16) to 2.57 (95% CI, 1.53–3.92) million. There was marked regional variation with most DALYs lost in sub-Saharan Africa (0.87 million, 95% CI, 0.43–1.70) and the Asia Pacific (0.39 million, 95% CI, 0.23–0.62) regions. The highest population-attributable fraction and burden were observed in Swaziland, Botswana, and Lesotho. Conclusions: People living with HIV are twice as likely to develop cardiovascular disease. The global burden of HIV-associated cardiovascular disease has tripled over the past 2 decades and is now responsible for 2.6 million DALYs per annum with the greatest impact in sub-Saharan Africa and the Asia Pacific regions. Clinical Trial Registration: URL: https://www.crd.york.ac.uk/prospero . Unique identifier: CRD42016048257.
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HIV patients have higher risk of cardiovascular events, even higher in those treated with protease inhibitors.
“HIV patients have been found to have a higher risk of cardiovascular events, which was even higher in patients treated with protease inhibitors (Friis‐Moller et al, 2007; Islam et al, 2012; Shah et al, 2018).”
From The struggle of a good friend getting old: cellular senescence in viral responses and therapy (2021) · cites this paper as Shah et al, 2018
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- Authors
- Shah, A. S. V., Stelzle, D., Lee, K. K., Beck, E. J., Alam, S., Clifford, S., Longenecker, C. T., Strachan, F., Bagchi, S., Whiteley, W., Rajagopalan, S., Kottilil, S., Nair, H., Newby, D. E., McAllister, D. A., & Mills, N. L.
- Affiliations
- University of Edinburgh (GB)
- Joint United Nations Programme on HIV/AIDS (CH)
- Case Western Reserve University (US)
- University of Maryland, Baltimore (US)
- University of Glasgow (GB)
- ORCID
- Venue
- Circulation
- Published
- 2018-09-11
- Volume
- 138
- Issue
- 11
- Pages
- 1100-1112
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- PMC
- PMC6221183
- OpenAlex
- W3025713364
- Cited by
- 975
- References
- 60
- Citations by year
- 2026: 139 · 2025: 153 · 2024: 159 · 2023: 117 · 2022: 137 · 2021: 111 · 2020: 99 · 2019: 51 · 2018: 8
- FWCI
- 82.17
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (acceptedVersion, cc-by-sa)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- mediaTUM – the media and publications repository of the Technical University Munich (Technical University Munich) (submittedVersion, other-oa)
- Edinburgh Research Explorer (University of Edinburgh) (submittedVersion, other-oa)
- Funders
- Wellcome Trust (201492/Z/16/Z)
- British Heart Foundation (FS/18/25/33454, FS/16/14/32023)
- University of Glasgow
- Topics
- Health Sciences › Medicine › Emergency Medicine › HIV-related health complications and treatments
- Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Keywords
- HIV-associated cardiovascular disease, atherosclerotic cardiovascular disease, global burden of disease, disability-adjusted life years, population attributable fraction, people living with HIV, antiretroviral therapy, sub-Saharan Africa, cardiovascular risk, non-communicable diseases, cardiovascular risk factors
- MeSH terms
- Adult, Female, Humans, Male, Middle Aged, Prognosis, Risk Factors, Time Factors, Global Health, HIV Infections, Incidence, Prevalence, Cost of Illness, Risk Assessment, HIV Long-Term Survivors, Atherosclerosis
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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