Prevalence of cardiovascular risk factors in Spanish HIV-1-infected male inmates

Abstract

Purpose of the study HIV-1-infected inmates have an increased prevalence of some particular comorbidities. However, the cardiovascular risk(CVR) of this population has rarely been evaluated. Methods Cross-sectional study carried out among 216 male HIV-1 patients in prison. Patients were stratified according to age(<34, 35-39, 40-44, 45-49, 50-54 and >55 years old, respectively)and their CVR was assessed by Framingham(FRAM) equation. The prevalence of some further risk factors was also evaluated: time on antiretroviral therapy, nadir CD4 count, maximum viral load(VL), time on undetectable VL, HCV-coinfection, and cocaine use. Results Patients median age was 41 years(36-46), their median CD4 count was 386(240- 549)cells, 68% had an undetectable(<50 c/mL)VL, median nadir CD4 count was 207(104-315)cells, and 48% of them had a nadir CD4 count <200 cells. HCV-coinfection prevalence was 94%, cocaine consumption prevalence was 93.1%, and 54.2% of them were intravenous cocaine users. The FRAM 10-years CVR score among subjects studied was 5.88%. Figure 1 and Table 1. Figure 1 CVR stratified by age group. Table 1 Cardiovascular risk factors prevalence stratified by age group. Age Smokers Diabetes Hypertension Tot Chol > 200 HDL Chol <39 <34 99,44% 0,00% 8,33% 13,89% 72,22% 35-39 100% 3,23% 8,07% 8,07% 43,55% 40-44 100% 3,60% 12,50% 23,20% 51,80% 45-49 100% 0,00% 4,65% 9,31% 60,00% 50-54 100% 26,67% 20% 13,34% 46,00% 55-60 100% 0,00% 75% 100% 0,00% Overall prevalence 99,07% 3,70% 10,60% 15,27% 53,24% P 0,455 0,029 0,023 0,001 0,029 Age(p<0.001), total cholesterol(p<0.001), HDL cholesterol(p = 0.029), diabetes mellitus(p = 0.029), hypertension(p = 0.023), and nadir CD4 <200 cells(p = 0.04) were significantly associated with an increased CVR. Smoking, chronic HCV-hepatitis, cocaine use, and the HIV-1 VL were not significantly associated with an increased CVR. There is a trend towards an increased prevalence of hypercholesterolemia and hypertension paralleling the aging. Conclusions Using the FRAM scores, the median CVR of developing a cardiac event at 10 years in a population of Spanish HIV-1-infected inmate males is 5.88%. Of them, 5.1% have a high CVR, and are evenly distributed among age groups. The smoking prevalence is significantly higher than in non-inmate HIV-1 infected individuals, and is so high that it does not allow CVR differences among age groups. HCV-coinfection, cocaine use, and parenteral cocaine consumption were not associated with an increased CVR in our population. On the other hand, a lower nadir CD4 count was associated with high rates of CVR, thus supporting an earlier initiation of ARV therapy in HIV-1 infected males in the prison environment.