JMIR Publications

ABSTRACT

Background:

The relationship between HIV-related biomarkers and cardiovascular risk among youth living with HIV (YLH) is understudied.

Objective:

Considering this gap, we examined whether detectable viral load (VL) and low CD4, indications of unsuppressed HIV, were associated with cardiovascular risk among YLH.

Methods:

We analyzed electronic health record data from 7 adolescent HIV clinics in the United States (N=813 YLH). Multivariable linear regression was used to assess the association of detectable VL and CD4 ≤ 200 with cardiovascular risk scores adapted from the Framingham gender-specific algorithm.

Results:

Nearly half of participants (47.8%) had detectable VL, indicating unsuppressed HIV, and 8.6% had CD4≤ 200, indicating impaired immune function. Cardiovascular risk was significantly increased in patients with CD4≤ 200 compared to those with CD4>200, as measured by Cardiac Risk Score 2 (p< 0.01). After adjusting for demographic and clinical covariates, we found that for a 1000-point increase in VL copies/mL, there was a 38% increase in the likelihood of having cardiovascular risk (Cardiac Risk Score 2). A small effect was observed for VL on increased cardiovascular risk when measuring the strength of this association (β=0.134, SE=0.014, p<0.01). We observed similar findings with Cardiac Risk Score 1 but the effect of CD4≤ 200 was no longer significant.

Conclusions:

Our findings indicate that detectable VL is associated with cardiovascular risk among YLH. Multi-component interventions that promote VL suppression, while concurrently targeting cardiovascular risk reduction, among YLH are warranted. If tailored specifically for youth, such an integrated approach could improve the overall well-being across the HIV continuum of care and over the life course.