Due to advances in treatment, people who have HIV (human immunodeficiency virus) are now living longer; they are, however, at risk for age-related diseases, such as cardiovascular diseases (CVDs). Compared to people who do not have HIV, people who have HIV have higher risk of heart attack or stroke later in life. It is unclear if, compared to people who do not have HIV, people who have HIV are also at higher risk of developing other important CVDs, such as peripheral arterial disease, heart failure, and angina. Some studies show that women with HIV have higher risk of developing heart attacks compared to women without HIV, but evidence is mixed. We expect that as people with HIV are treated promptly, live longer, and their immune status improves to levels close that in people without HIV, the risk of developing CVDs would be almost similar in the two groups; there remains little evidence of this effect. The proposed study aims to use linked general practice and hospital data to examine the association of having HIV and developing various CVDs. Findings will guide health care professionals and policymakers in prioritising interventions and reducing the health burden and costs associated with HIV.
We will use structured, national linked electronic health records from primary care (from the Clinical Practice Research Datalink), hospital care (from Hospital Episode Statistics), and mortality (from the Office of National Statistics) to examine: (i) associations of HIV-serostatus and incidence of heterogeneous cardiovascular, cerebrovascular, and peripheral arterial diseases among individuals with no prior history of these diseases and (ii) how risk factors for these conditions might be differential by HIV status.
Patients registered with consenting general practices will be selected using an open cohort design, and will be censored at first occurrence of disease of interest (any of: stable or unstable angina, non-fatal myocardial infarction, unheralded coronary heart disease death, heart failure, sudden cardiac death, transient ischemic attack, ischemic stroke, subarachnoid haemorrhage, intracerebral haemorrhage, abdominal aortic aneurysm, peripheral arterial disease, and atrial fibrillation), last date of practice data collection, or at end of the study period. For each of the diseases we will: (i) calculate cumulative and excess incidence rates (95%CIs) per 100,000 person-years by HIV-serostatus, (ii) use disease-specific Cox proportional hazards models to derive hazard ratios (95%CIs) for initial presentation by HIV-serostatus (adjusted for relevant covariates) and to assess time trends in relative risk of each CVD by calendar time period.
Spiros Denaxas - Chief Investigator - University College London ( UCL )
Marina Daskalopoulou - Corresponding Applicant - University College London ( UCL )
Andrew Philips - Collaborator - University College London ( UCL )
Arturo Gonzalez-Izquierdo - Collaborator - University College London ( UCL )
Liam Smeeth - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
HES Admitted Patient Care;ONS Death Registration Data;Patient Level Index of Multiple Deprivation