TY - JOUR
T1 - Residual HIV viremia strongly increases cardiovascular disease incidence independent of classical risk factors
AU - Otten, Twan
AU - Ruijten, Suzanne D E
AU - Blaauw, Marc J T
AU - Delporte, Mareva
AU - Navas, Adriana
AU - Vos, Wilhelm A
AU - Groenendijk, Albert L
AU - van Eekeren, Louise E
AU - Vadaq, Nadira
AU - Hageman, Steven
AU - Matzaraki, Vasiliki
AU - Richel, Olivier
AU - Berrevoets, Marvin
AU - Verbon, Annelies
AU - Stalenhoef, Janneke
AU - Arts, Rob
AU - Lunzen, Jan van
AU - Riksen, Niels P
AU - Vandekerckhove, Linos
AU - Netea, Mihai G
AU - van der Ven, André J
N1 - Publisher Copyright:
© 2026 The Author(s). Published by Elsevier Ltd on behalf of British Infection Association. This is an open access article under the CC BY license. http://creativecommons.org/licenses/by/4.0/
PY - 2026/5
Y1 - 2026/5
N2 - SummaryBackgroundPeople with HIV (PWH) using antiretroviral therapy are at increased risk to develop cardiovascular diseases (CVD). We hypothesized that residual viremia (RV; unquantifiable low, but detectable viral load) increases CVD risk.MethodsWe enrolled 1895 virally suppressed PWH and compared CVD incidence in participants with and without RV. Extensive multi-omics characterization was performed. Incident CVD was registered after 2-year follow-up and adjusted odds ratios (aOR) calculated accounting for classical CVD risk factors. The numbers of expected and actual CVD events were compared using CVD risk scores.FindingsRV, detected in one-third of participants, strongly increased the risk of developing a first cardiovascular event (3.1% vs 1.2%, aOR 2.8, p=0.004). Participants with RV experienced twice the number of events predicted by the SCORE2 risk model. The association between RV and CVD was not driven by inflammation, immune activation, gut barrier dysfunction, or lipometabolic perturbations.InterpretationResidual viremia independently associated with CVD development, highlighting the need for tailored prevention and examination of novel intervention strategies.
AB - SummaryBackgroundPeople with HIV (PWH) using antiretroviral therapy are at increased risk to develop cardiovascular diseases (CVD). We hypothesized that residual viremia (RV; unquantifiable low, but detectable viral load) increases CVD risk.MethodsWe enrolled 1895 virally suppressed PWH and compared CVD incidence in participants with and without RV. Extensive multi-omics characterization was performed. Incident CVD was registered after 2-year follow-up and adjusted odds ratios (aOR) calculated accounting for classical CVD risk factors. The numbers of expected and actual CVD events were compared using CVD risk scores.FindingsRV, detected in one-third of participants, strongly increased the risk of developing a first cardiovascular event (3.1% vs 1.2%, aOR 2.8, p=0.004). Participants with RV experienced twice the number of events predicted by the SCORE2 risk model. The association between RV and CVD was not driven by inflammation, immune activation, gut barrier dysfunction, or lipometabolic perturbations.InterpretationResidual viremia independently associated with CVD development, highlighting the need for tailored prevention and examination of novel intervention strategies.
U2 - 10.1016/j.jinf.2026.106737
DO - 10.1016/j.jinf.2026.106737
M3 - Article
C2 - 41865843
SN - 0163-4453
VL - 92
JO - The Journal of Infection
JF - The Journal of Infection
IS - 5
M1 - 106737
ER -