Data Reveals Chronic Disease Burden Among Individuals with HIV

The first collection of important data from the world’s largest study of cardiovascular disease prevention in people with HIV has revealed the significant chronic disease burden of this patient population.

The NIH-funded study, known as Randomized Trial to Prevent Vascular Events in HIV (REPRIEVE), enrolled 7,770 participants from 2015 to 2019 across more than 100 clinical research sites in 12 countries and five continents. The global collaboration is expected to report its findings to the public in 2023.

The study aims to give medical professionals an advance look at the disproportionate risk of comorbidities like cardiovascular disease, chronic liver and kidney disease, physical function impairment and frailty, premature reproductive aging, cancer, and obesity in people with HIV from regions all over the world.

Massachusetts General Hospital (MGH) is serving as the clinical coordinating center for REPRIEVE while also coordinating data collection for the trial with the Harvard T.H. Chan School of Public Health.

“With nearly half of all people living with HIV now over 50, the emphasis among healthcare providers has shifted over the past 20 years from keeping patients alive through antiretroviral therapy to providing the best possible care for secondary co-morbid conditions encountered over greatly increased lifespans,” said Steven Grinspoon, MD, chief of the MGH Metabolism Unit professor of Medicine, Harvard Medical School and co-principal investigator of REPRIEVE.

“The release of this initial baseline data from REPRIEVE will help physicians and researchers to better understand the whole person impact of HIV, and ultimately to develop more effective preventions, treatment strategies and guidelines for cardiovascular risk management in this population. In a very real way, co-morbidities are the newest frontier of HIV.”

MGH will oversee serial assessment of coronary atherosclerosis at 30 sites across the US using the latest noninvasive CT angiography technology.

“Imaging the specific patterns of coronary artery disease will help us to better stratify cardiovascular risk in the REPRIEVE population,” said Udo Hoffmann, MD, MPH, professor of Radiology, Harvard Medical School and co-principal investigator of REPRIEVE.   

Although the major goal of REPRIEVE is to reduce major adverse cardiovascular events in people with HIV through a cardiac prevention strategy, the global initiative is also evaluating non-cardiovascular disease comorbidities.

The initial datasets reveal that physical function impairment and pre-frailty are common among middle-aged people with HIV, and that body-mass index (BMI) and physical activity are key modifiable risk factors that may prevent further decline in function with aging among this population.

Additionally, initial findings show that reproductive aging in middle-aged women with HIV is associated with global burden of disease (GBD) region of enrollment, and may predispose these women to increased cardiometabolic risk. The research also examines the factors contributing to increased kidney dysfunction and increased ectopic fat deposition in the heart among people with HIV.

The study aims to help healthcare providers deliver optimal chronic disease management and care to patients with HIV.

“This initial compilation of data from the landmark REPRIEVE study offers a rich window on the kinds of diseases physicians find themselves treating at a time when the HIV demographic is changing as the result of effective antiretroviral drugs, increasing life expectancies, and the substantial growth of cardiovascular disease and other comorbidities in a still vulnerable population,” said Grinspoon.

“By shedding light for the first time on the magnitude and complexity of the problem, we believe this information and more to follow will play a critical role in developing cardiac prevention strategies along with improved healthcare for the 37 million people living with HIV globally.”