This transcript has been edited for clarity and length.
Hi, I'm David Wohl, a professor of medicine in the division of infectious diseases at the University of North Carolina. At the International AIDS Conference in Montreal, there were a lot of different data about some of the big-ticket things that we care a lot about nowadays in HIV. There was certainly a lot about prevention, long-acting injectables for prevention, and long-acting injectables for treatment. There was also quite a bit of information about newer drugs and even cure.
When we talk about comorbidities or aging, a lot of it is handwringing. It's stuff we know about that people living with HIV might be at greater risk for—comorbidities, frailty, and outcomes that are associated with getting older. One of the findings that I thought was among the most interesting within that realm was an analysis that was done by a colleague of mine here at the University of North Carolina, Tonia Poteat. She and her colleagues looked at large sets of data, including from the WIHS [Women’s Interagency HIV Study] cohort.
Many of us know about the MACS [Multicenter AIDS Cohort Study] cohort that looks at HIV-positive men and HIV-negative men, and compares their outcomes over a long period of time. It's a legacy study [that has] been going on for decades. WIHS is the component that looks at the same sort of issues among women, looking at women who are living with HIV and women at risk for HIV, mostly in large metropolitan areas in the United States.
Tonia Poteat and her group looked at women, including those women in WIHS—about 1300 HIV-positive cisgender women, about 520 cisgender HIV-negative women, and transgender women [with HIV] from another cohort, but only about 25 of them. This is largely an analysis looking at cisgender women living with and without HIV.
They looked at cardiovascular risk as assessed by a cardiovascular risk calculator and the factors that were associated with a [risk score of] 7.5%, [an indicator of] increased risk of cardiovascular disease over the next 10 years. And they also looked at the normal things that you would look at, the routine things, including age, HIV status, demographics, and body mass index (BMI).
Overall, across the three groups (cisgender women with HIV, cisgender women without HIV, and transgender women with HIV), the average age was in the mid-fifties. Their racial and ethnic breakdowns were pretty similar, with about two-thirds of them being women of color. BMI was also very similar, about 30 to 32 kg/m² across the three [groups]. There's really good balance as far as some of the traditional risk factors. Smoking, as well; about a third to half were current smokers.
Among the people living with HIV, the majority of them had a viral load that was suppressed under 200 [copies], over 80%. So, really good data that help us understand these cohorts and their risk.
They put this all into a complicated series of multivariable analyses, different models, and tried to understand—looking at all these things together in a fairly large cohort of these folks—what were the independent risk factors for someone having a high risk for cardiovascular disease, a risk that we would all agree should be intervened on, that we should do something to reduce that cardiovascular risk profile?
Interestingly, when you look at it, age definitely was statistically significant, which would make sense. I think it validates the model, because if age didn't shake out, there'd be something wrong. Per each year of age, there were increased odds of having a cardiovascular risk score of 7.5% or more. With the few women who were transgender women, [gender identity] didn't have an influence. Neither did HIV status. This is really important: HIV status was not associated with high cardiovascular disease risk prediction in this cohort of women. That's key.
And I think that these women, when we look at the data for at-risk women in WIHS, we see that they do suffer from a lot of comorbidities that sometimes we associate with living with HIV. And that tells you that these two groups of women may [have] similar environmental stresses or lifestyle choices that can contribute to morbidities like cardiovascular disease. African Americans and people of color wore more at risk compared with white people for having a higher score.
Importantly, the researchers assessed depression using a validated scale. This was very significant in their most rigorous multivariable analysis: depression score was associated with cardiovascular risk. That’s key because this has been shown before, but I don’t think it gets the attention that it should.
When we see data, including at this conference and others, that show that people living with HIV are at higher risk of cardiovascular disease, frailty, or these other things, sometimes they don’t measure things like stress, prejudice, living with discrimination, or depression. And, unfortunately, those things can be operative in leading to risk for some of these poor outcomes. I feel it’s very important that we incorporate that; those are unmeasured confounders. And this study identified this as being a major, major driver of predicted risk for cardiovascular disease.
It's an important study. It was a poster and wasn't presented. I haven't seen much attention to this, but it really does motivate us to make sure we're screening for depression in everyone, but especially women—trans women and cisgender women. If there is depression, this study suggests that working the depression—making sure we're treating depression appropriately and the substance use that comes with it, the smoking that may be accompanying this—can lead to benefit in reducing risk for cardiovascular disease. So again, a take-home message for me that I'm going to incorporate more and more into my own clinical practice.
