Cardiovascular Events and Mortality in HIV-Positive vs HIV-Negative Patients in Northern Uganda

Overview

This retrospective cohort study of 2,127 hospitalized cardiovascular disease patients in northern Uganda assessed all-cause mortality and major adverse cardiovascular events (MACE) in individuals with and without HIV. The study found that HIV infection modifies the risk of in-hospital mortality associated with MACE, highlighting the increased cardiovascular risk and mortality burden among people living with HIV.

Background

Globally, over 40 million people live with HIV, with two-thirds residing in sub-Saharan Africa. Advances in antiretroviral therapy have reduced HIV-related mortality, but non-communicable diseases, especially cardiovascular diseases (CVD), remain leading causes of death in people living with HIV (PLWH). HIV infection increases the risk of major adverse cardiovascular events such as acute myocardial infarction, stroke, and heart failure. Despite expanded ART availability, disparities in cardiovascular outcomes persist in low-income settings, and data on cardiovascular morbidity and mortality in PLWH in sub-Saharan Africa remain limited.

Data Highlights

The study included 2,127 adult patients hospitalized with cardiovascular disease at two referral hospitals in northern Uganda from 2015 to 2023. Patients were stratified by HIV status and presence of major adverse cardiovascular events (heart failure, acute myocardial infarction, stroke). Mortality outcomes and odds of death were analyzed to assess the association between HIV infection, MACE, and in-hospital mortality.

Key Findings

• People living with HIV hospitalized for cardiovascular disease had higher odds of all-cause in-hospital mortality compared to HIV-negative patients.
• Major adverse cardiovascular events (heart failure, acute myocardial infarction, stroke) were strongly associated with increased mortality risk in both HIV-positive and HIV-negative groups.
• HIV infection modified the relationship between MACE and mortality, indicating a synergistic effect increasing the risk of death during hospitalization.
• Traditional cardiovascular risk factors such as hypertension and smoking, combined with HIV infection and prolonged ART, exacerbate cardiovascular risk.
• Despite ART availability, cardiovascular morbidity and mortality remain disproportionately high in PLWH in sub-Saharan Africa.

Clinical Implications

Clinicians should recognize the elevated cardiovascular risk and mortality in people living with HIV, especially when hospitalized with major adverse cardiovascular events. Integrated management strategies addressing both HIV and cardiovascular risk factors are essential to reduce mortality. Early identification and aggressive treatment of hypertension and other modifiable risk factors in PLWH may improve cardiovascular outcomes in resource-limited settings.

Conclusion

This study highlights the increased risk of in-hospital mortality associated with major adverse cardiovascular events in people living with HIV in northern Uganda. HIV infection modifies the mortality risk, underscoring the need for targeted cardiovascular prevention and management strategies in this population.

References

1. UNAIDS/WHO/2024 -- Global HIV/AIDS Statistics and Mortality
2. Global Burden of Cardiovascular Disease/WHO/2024 -- Cardiovascular Disease Mortality and Risk Factors
3. Regional HIV and Cardiovascular Research/Various/2024 -- Cardiovascular Disease in People Living with HIV in Sub-Saharan Africa