Abstract
Background: Cardiovascular disease (CVD) is the leading cause of death in persons living with HIV (PLWH). CVD risk in PLWH is often underestimated, and sex stratified analyses are lacking. We sought to investigate the prevalence of CVD and associated viremic and metabolic risk factors in a cohort of men and women living with HIV (MLWH and WLWH respectively). Methods: A retrospective chart review of PLWH seen at the University of Miami/Jackson Memorial Hospital outpatient HIV clinics between 2017-2019 was performed. Demographic, clinical, and laboratory data along with diagnostic studies were obtained from electronic health records. Results: A total of 985 patient charts were reviewed, among which 102 patients had one or more manifestations of CVD. Among WLWH and MLWH, overall prevalence of CVD was comparable (9.6% vs 11.0%, p=0.49). Compared to MLWH, WLWH had lower prevalence of atrial fibrillation (0.7% vs 2.2%, p=0.04) but comparable coronary artery disease, peripheral arterial disease, heart failure, and history of stroke or myocardial infarction. Among patients with CVD, WLWH and MLWH were similar in age (61.2±8.4 vs. 58.7±9.8 years, p=0.18) and had no significant differences in race or ethnicity. No differences were noted between genders in systolic blood pressure or LDL-C, although WLWH showed a trend of increased hemoglobin A1c (6.7±1.7 vs. 6.1±1.2, p=0.07), and BMI (29.9±7.6 vs. 27.3±6.2, p=0.06). Of note, WLWH had a higher average CD4 count compared to MLWH (613±335 vs 460±330 cells/mm 3 , p=0.01), but comparable antiretroviral therapy (ART) adherence (90.7% vs 84.7%, p=0.39), and presence of undetectable viral load (64.3% vs 67.2%, p=0.76). On multivariate logistic regression adjusted for age, race, viremia, and comorbidities, having diabetes was associated with increased CVD risk (OR=1.69, 95% CI [1.03-2.79], p=0.04). ART treatment was associated with decreased CVD risk (OR=0.30, 95% CI [0.14-0.65], p=0.002), while female gender was not (OR=0.76, 95% CI [0.48-1.20], p=0.24). Conclusion: Men and women living with HIV had comparable prevalence of CVD. This may be associated with a trend towards increased traditional risk factors among WLWH. Improving ART adherence and viremic control is vital to reducing CVD risk in this population.