Background: Major adverse cardiovascular events (MACEs) may contribute to the high morbidity in people with four-class drug-resistant HIV (4DR-PWH). Objectives: To explore the probability of MACEs in 4DR-PWH compared with non-4DR controls. Methods: This was a retrospective, propensity score-matched cohort study on 4DR-PWH (cases) and non-4DR-PWH (controls), on ART, without previous MACEs. Controls were matched with cases in a 4:1 ratio for age, sex-assigned-at-birth and ART duration. Incidence rates (IRs) and incidence rate ratio (IRR) of MACEs with 95% CIs were modelled by Poisson regression. Cumulative probabilities of the first incident MACE were estimated by Kaplan-Meier curves. A multivariable stepwise Cox proportional hazards model estimated predictors of incident MACEs among covariates with univariable P < 0.100. Results: Overall, 223 4DR-PWH and 797 non-4DR-PWH were evaluated. During a median (IQR) follow-up of 8.2 (5.4-11.1) years [1833 person-years of follow-up (PY)], 23/223 (10.3%) 4DR-PWH developed 29 MACEs, IR = 1.6 (95% CI = 1.1-2.3)/100 PY. During a median follow-up of 8.4 (5.2-11.0) years (6450 PY), 42/797 (5.3%) non-4DR controls had 45 MACEs, IR = 0.7 (95% CI = 0.5-0.9)/100 PY, IRR (4DR/non-4DR) = 2.3 (95% CI = 1.4-3.6). The cumulative probabilities of the first MACE were more than doubled in 4DR-PWH (P = 0.006). At multivariable analysis, an increased risk of MACEs was associated with 4DR status [adjusted hazard ratio (aHR) = 1.9; 95% CI = 1.0-3.4], after adjusting for age, sex-assigned-at-birth, HIV load, CD4+ nadir, total cholesterol, HDL cholesterol, diabetes mellitus, statin use and baseline HCV serostatus. Conclusions: In PWH, MDR is significantly associated with a higher risk of cardiovascular events. Prompt implementation of prevention strategies is mandatory in this fragile population.
Two-fold increased risk of cardiovascular events in people with MDR HIV: a matched cohort analysis with data from the PRESTIGIO registry / Clemente, Tommaso; Diotallevi, Sara; Minisci, Davide; Di Biagio, Antonio; Lolatto, Riccardo; Attala, Letizia; Cenderello, Giovanni; Siribelli, Alessia; Muccini, Camilla; Lo Caputo, Sergio; Tavio, Marcello; Papaioannu Borjesson, Rebecka; Giacomelli, Andrea; Castagna, Antonella; Spagnuolo, Vincenzo; null, null; Castagna, Antonella; Spagnuolo, Vincenzo; Armenia, Daniele; Bonora, Stefano; Calza, Leonardo; Cattelan, Anna Maria; Cenderello, Giovanni; Cervo, Adriana; Comi, Laura; Di Biagio, Antonio; Focà, Emanuele; Gagliardini, Roberta; Giacomelli, Andrea; Lagi, Filippo; Marchetti, Giulia; Rusconi, Stefano; Saladini, Francesco; Santoro, Maria Mercedes; Zazzi, Maurizio; Galli, Andrea; Armenia, Daniele; Saladini, Francesco; Santoro, Maria Mercedes; Zazzi, Maurizio; Carini, Elisabetta; Bagaglio, Sabrina; Piromall, Girolamo; Lolatto, Riccardo; Tavio, Marcello; Paggi, Alessandra Mataloni; Schioppa, Ornella; Da Ros, Valentina; Saracino, Annalisa; Balena, Flavia; Comi, Laura; Valenti, Daniela; Suardi, Claudia; Viale, Pierluigi; Calza, Leonardo; Malerba, Federica; Cretella, Silvia; Riccardi, Riccardo; Castelli, Francesco; Focà, Emanuele; Minisci, Davide; Pennati, Francesca; Menzaghi, Barbara; Farinazzo, Maddalena; Cacopardo, Bruno; Celesia, Maurizio; Raddusa, Michele Salvatore Paternò; Giarratana, Carmen; Fusco, Paolo; Olivadese, Vincenzo; Pan, Angelo; Fornabaio, Chiara; Brambilla, Paola; Bartoloni, Alessandro; Lagi, Filippo; Corsi, Paola; Kiros, Seble Tekle; Ducci, Filippo; Giachè, Susanna; Costa, Cecilia; Bellucci, Alessio; Mirabelli, Elisa; Santantonio, Teresa; Lo Caputo, Sergio; Ferrara, Sergio; Narducci, Arianna; Pontali, Emanuele; Feasi, Marcello; Sarà, Antonio; Bassetti, Matteo; Di Biagio, Antonio; Blanchi, Sabrina; Castagna, Antonella; Spagnuolo, Vincenzo; Muccini, Camilla; Carini, Elisabetta; Bagaglio, Sabrina; Lolatto, Riccardo; Galli, Andrea; Borjesson, Rebecka Papaioannu; Clemente, Tommaso; Piromalli, Girolamo; Antinori, Spinello; Giacomelli, Andrea; Formenti, Tiziana; Schiavo, Fabiola; Marchetti, Giulia; Gazzola, Lidia; Fineo, Fabiana Trionfo; Puoti, Massimo; Moioli, Cristina; D'Amico, Federico; Mussini, Cristina; Cervo, Adriana; Manzillo, Elio; Lanzardo, Amedeo; Cattelan, Anna Maria; Mazzitelli, Maria; Cascio, Antonio; Trizzino, Marcello; Fronti, Elisa; Laccabue, Diletta; Carli, Federica; Gulminetti, Roberto; Pagnucco, Layla; Demitri, Mattia; Francisci, Daniela; De Socio, Giuseppe; Schiaroli, Elisabetta; Garlassi, Elisa; Corsini, Romina; Gagliardini, Roberta; Fusto, Marisa; Sarmati, Loredana; Malagnino, Vincenzo; Mulas, Tiziana; Torti, Mirko Compagno Carlo; Di Giambenedetto, Simona; Lamonica, Silvia; Salvo, Pierluigi Francesco; Cenderello, Giovanni; Pincino, Rachele; Tumbarello, Mario; Fabbiani, Massimiliano; Panza, Francesca; Rancan, Ilaria; Di Perri, Giovanni; Bonora, Stefano; Ferrara, Micol; Calcagno, Andrea; Fantino, Silvia; Nardi, Stefano; Fiscon, Marta. - In: JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY. - ISSN 0305-7453. - ELETTRONICO. - 80:(2025), pp. 731-737. [10.1093/jac/dkae465]
Two-fold increased risk of cardiovascular events in people with MDR HIV: a matched cohort analysis with data from the PRESTIGIO registry
Di Biagio, Antonio;Attala, Letizia;Di Biagio, Antonio;Lagi, Filippo;Marchetti, Giulia;Castelli, Francesco;Bartoloni, Alessandro;Lagi, Filippo;Kiros, Seble Tekle;Ducci, Filippo;Bellucci, Alessio;Mirabelli, Elisa;Di Biagio, Antonio;Marchetti, Giulia;Tumbarello, Mario;Panza, Francesca;Rancan, Ilaria;Nardi, Stefano;
2025
Abstract
Background: Major adverse cardiovascular events (MACEs) may contribute to the high morbidity in people with four-class drug-resistant HIV (4DR-PWH). Objectives: To explore the probability of MACEs in 4DR-PWH compared with non-4DR controls. Methods: This was a retrospective, propensity score-matched cohort study on 4DR-PWH (cases) and non-4DR-PWH (controls), on ART, without previous MACEs. Controls were matched with cases in a 4:1 ratio for age, sex-assigned-at-birth and ART duration. Incidence rates (IRs) and incidence rate ratio (IRR) of MACEs with 95% CIs were modelled by Poisson regression. Cumulative probabilities of the first incident MACE were estimated by Kaplan-Meier curves. A multivariable stepwise Cox proportional hazards model estimated predictors of incident MACEs among covariates with univariable P < 0.100. Results: Overall, 223 4DR-PWH and 797 non-4DR-PWH were evaluated. During a median (IQR) follow-up of 8.2 (5.4-11.1) years [1833 person-years of follow-up (PY)], 23/223 (10.3%) 4DR-PWH developed 29 MACEs, IR = 1.6 (95% CI = 1.1-2.3)/100 PY. During a median follow-up of 8.4 (5.2-11.0) years (6450 PY), 42/797 (5.3%) non-4DR controls had 45 MACEs, IR = 0.7 (95% CI = 0.5-0.9)/100 PY, IRR (4DR/non-4DR) = 2.3 (95% CI = 1.4-3.6). The cumulative probabilities of the first MACE were more than doubled in 4DR-PWH (P = 0.006). At multivariable analysis, an increased risk of MACEs was associated with 4DR status [adjusted hazard ratio (aHR) = 1.9; 95% CI = 1.0-3.4], after adjusting for age, sex-assigned-at-birth, HIV load, CD4+ nadir, total cholesterol, HDL cholesterol, diabetes mellitus, statin use and baseline HCV serostatus. Conclusions: In PWH, MDR is significantly associated with a higher risk of cardiovascular events. Prompt implementation of prevention strategies is mandatory in this fragile population.
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