Background
Despite extensive research, it is unclear why the high cardiovascular disease (CVD) burden in people with HIV has endured for decades. One potential explanation is that elevated CVD risk is the result of the combined effects of social and biological factors in people with HIV which has received limited attention.
Methods
We identified all adult (≥18 years) people with HIV with at least 1-year of continuous membership enrolled in Kaiser Permanente (KP) Northern California and KP Mid-Atlantic between 2000 – 2022. The study sample excluded people with HIV with prior history of a Major Adverse Cardiovascular Events (MACE). We used latent class analysis (LCA) to identify classes of people with HIV with similar patterns of healthcare access, social vulnerability (census-based CDC social vulnerability index themes), mental health (MH) (depression or anxiety) and substance use (SU) (smoking status and SU disorders), and CVD risk factors (see Figure for individual risk factors). Bayesian information criterion was used to determine model complexity and fit. We then used Cox proportional hazard models to estimate the hazard ratio (HR) of incident MACE by LCA class, adjusting for age, race, sex, start of follow up year, years of prior enrollment, and KP region.
Results
The study sample included 25,510 people with HIV separated into 6 classes (Figure). Probabilities for individual risk factors from LCA were used to qualitatively name the 6 classes (see labels in Figure). In adjusted models, Class 5 (high CVD risk) [HR: 1.90; 95% CI 1.57-2.30] and Class 6 (high CVD and social vulnerability risk) [2.62; 1.94-3.52] had a higher risk of incident MACE compared with Class 1 (low overall risk). Class 2 (mixed social vulnerability risk) [1.11; 0.95-1.31], Class 3 (high social vulnerability risk) [1.16; 0.99-1.36], and Class 4 (high MH/SU risk factors) [1.22; 0.99-1.51] also had a higher, but not statistically significant, risk of incident MACE compared with the low overall risk class.
Conclusions
We identified 2 classes with increased risk of MACE, both of which included people with HIV with a higher prevalence of CVD risk factors. What distinguished these classes was that one had a high prevalence of social vulnerability risk factors while the other did not, suggesting distinct targeted efforts may be needed to close the CVD gap among people with HIV.
Table or Figure
