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Background <p>Advances in antiretroviral therapy (ART) have substantially increased life expectancy among people living with HIV (PLHIV), shifting morbidity toward chronic noncommunicable diseases. Cardiovascular and cerebrovascular diseases have therefore emerged as major contributors to long-term morbidity. This study assessed the long-term risk of cardiovascular and cerebrovascular events among PLHIV in Germany.</p> Methods <p>In this retrospective cohort study using the IQVIA<sup>™</sup> Disease Analyzer database, people living with HIV (PLHIV) were compared with a propensity score-matched HIV-negative cohort. Four cardiovascular outcomes-myocardial infarction (MI), chronic coronary heart disease (CHD), ischemic stroke/transient ischemic attack (TIA), and a composite cardiovascular endpoint-were defined as primary outcomes. Associations were assessed using Cox proportional hazards models. To account for multiple testing across the four primary comparisons, statistical significance was defined as <i>p</i> &lt; 0.01. Age- and sex-stratified analyses were considered secondary exploratory analyses.</p> Results <p>HIV status was not associated with a statistically significant increase in MI (HR 1.48; 95% CI 0.98–2.21), CHD (HR 1.19; 95% CI 1.00–1.42), or ischemic stroke/TIA (HR 1.35; 95% CI 1.02–1.78). In contrast, HIV status was significantly associated with the composite cardiovascular endpoint (HR 1.27; 95% CI 1.05–1.45; <i>p</i> = 0.004). Hazard ratios were consistently elevated across outcomes. In exploratory age-stratified analyses, the risk estimate for ischemic stroke/TIA was higher among individuals aged ≤ 50&#xa0;years (HR 2.01; 95% CI 1.20–3.35).</p> Conclusion <p>HIV status was significantly associated with the composite cardiovascular endpoint among PLHIV. Individual outcomes did not reach statistical significance at the predefined threshold. Consistently elevated hazard ratios across individual outcomes and higher risk estimates in younger individuals suggest a <i>potentially</i> clinically meaningful increase in cardiovascular and cerebrovascular risk in this population. Further studies incorporating HIV-specific clinical data are warranted.</p>

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Cardiovascular and cerebrovascular outcomes in people living with HIV: a matched cohort study in German primary care

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  • 发表日期：

    2026年6月22日

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  • Sarah Krieg,
  • Andreas Krieg,
  • Karel Kostev

摘要

Background

Advances in antiretroviral therapy (ART) have substantially increased life expectancy among people living with HIV (PLHIV), shifting morbidity toward chronic noncommunicable diseases. Cardiovascular and cerebrovascular diseases have therefore emerged as major contributors to long-term morbidity. This study assessed the long-term risk of cardiovascular and cerebrovascular events among PLHIV in Germany.

Methods

In this retrospective cohort study using the IQVIA™ Disease Analyzer database, people living with HIV (PLHIV) were compared with a propensity score-matched HIV-negative cohort. Four cardiovascular outcomes-myocardial infarction (MI), chronic coronary heart disease (CHD), ischemic stroke/transient ischemic attack (TIA), and a composite cardiovascular endpoint-were defined as primary outcomes. Associations were assessed using Cox proportional hazards models. To account for multiple testing across the four primary comparisons, statistical significance was defined as p < 0.01. Age- and sex-stratified analyses were considered secondary exploratory analyses.

Results

HIV status was not associated with a statistically significant increase in MI (HR 1.48; 95% CI 0.98–2.21), CHD (HR 1.19; 95% CI 1.00–1.42), or ischemic stroke/TIA (HR 1.35; 95% CI 1.02–1.78). In contrast, HIV status was significantly associated with the composite cardiovascular endpoint (HR 1.27; 95% CI 1.05–1.45; p = 0.004). Hazard ratios were consistently elevated across outcomes. In exploratory age-stratified analyses, the risk estimate for ischemic stroke/TIA was higher among individuals aged ≤ 50 years (HR 2.01; 95% CI 1.20–3.35).

Conclusion

HIV status was significantly associated with the composite cardiovascular endpoint among PLHIV. Individual outcomes did not reach statistical significance at the predefined threshold. Consistently elevated hazard ratios across individual outcomes and higher risk estimates in younger individuals suggest a potentially clinically meaningful increase in cardiovascular and cerebrovascular risk in this population. Further studies incorporating HIV-specific clinical data are warranted.