Cardiovascular disease in people living with HIV in Malaysia: A competing risks cohort analysis

PURPOSE: Cardiovascular disease (CVD) is an emerging health concern among people living with HIV (PLHIV), particularly in Asian settings where evidence remains limited. We aimed to estimate the cumulative risk of CVD among PLHIV in Malaysia, in the presence of competing risk from non-CVD deaths, and to identify associated risk factors.

METHODS: We conducted a retrospective cohort study using data from the Malaysian Antiretroviral Therapy Cohort (MATCH), including adults diagnosed with HIV between 2007 and 2023. Individuals with prior CVD were excluded. The primary outcome was a composite of CVD events, with non-CVD death treated as a competing risk. We estimated cumulative incidence functions (CIFs) and incidence rates (IRs) per 1000 person-years (PYs), and assessed associations using Fine and Grey subdistribution hazard models, with cause-specific Cox models as secondary analysis.

RESULTS: Among 7098 PLHIV, 287 (4.0%) developed CVD over 61 936 PY (IR: 4.63 per 1000 PY; 95% CI: 4.11-5.20). The cumulative CVD risk was 1.9% at 5 years, 3.8% at 10 years, and 7.1% at 15 years post-diagnosis. Older age (subdistribution hazard ratio (sHR): 1.07 per year), Indian (sHR: 2.27), and Malay ethnicity (sHR: 1.81) were associated with a higher risk. Abacavir use was significantly associated with CVD (sHR: 2.48). PI use showed a borderline association in the main model (sHR: 1.47) but was significant in the secondary analysis (aHR: 1.86). Other antiretroviral classes were not significant.

CONCLUSION: CVD risk among PLHIV is non-negligible. Integrating CVD prevention into HIV care is critical, particularly for older adults and those on specific ART regimens.