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Principal Investigator: Derek D Satre
Organization: KAISER FOUNDATION RESEARCH INSTITUTE
Fiscal Year: 2024
Award: $770,930
Funding agency: National Heart Lung and Blood Institute
PROJECT SUMMARY/ABSTRACT
Combination antiretroviral therapy (ART) has led to dramatic declines in morbidity and mortality for people with
HIV (PWH). However, as PWH age, the risk of cardiovascular disease (CVD) has increased, with a projected
lifetime burden among PWH of 65% for men and 44% for women. The higher observed risk of CVD in PWH
compared with the general population is a result of the higher prevalence of established CVD risk factors
(smoking, alcohol, dyslipidemia), and direct effects of HIV infection, including immunodeficiency and
inflammation. Recent studies have also implicated integrase strand inhibitors and other ART with increases in
body weight, which may further increase risk of CVD. There are also many understudied social and economic
conditions that may contribute to the high CVD risk in PWH, including disparities in healthcare access and
treatment, social isolation, history of trauma, and HIV stigma. While most studies have considered the impact
of CVD risk factors in isolation, it is well known that many frequently co-occur, such as smoking, alcohol,
obesity and depression. Furthermore, the ways in which social factors exacerbate the effect of biomedical CVD
risk factors among PWH is not well understood. Using a syndemics framework, which is uniquely suited for the
evaluation of the clustering of social and biological conditions in vulnerable populations, we will investigate
reasons for the persistently high risk of CVD among PWH. With the team’s interdisciplinary expertise in HIV,
CVD and syndemics, our study is designed to understand how social, economic and biological factors combine
in PWH, contributing to their high CVD risk. We will leverage comprehensive electronic health record (EHR)
data from Kaiser Permanente (KP) and detailed existing survey and biospecimen from the KP Research Bank
(KPRB). In Aim 1, we will examine synergistic relationships with major adverse cardiovascular events (MACE)
among 29,000 PWH and 1:20 matched people without HIV (PWoH) enrolled in KP from 2000-2021. We will
evaluate clusters of social and biological factors available in EHRs such as mental health, substance use
disorders (SUD), neighborhood deprivation, and insurance benefits. For Aim 2, we will perform a
complementary study within the KPRB to identify synergistic relationships with subclinical CVD among 1,969
PWH (709 with biospecimens) and 1:1 matched PWoH. We will consider additional social factors from surveys
that may impact CVD risk, including discrimination and stigma, social isolation, emotional and practical health
support, and economic factors. Finally, Aim 3 will involve recruitment of 60 PWH from high-risk clusters
identified in Aims 1 and 2 for in-depth qualitative interviews to explore how the syndemic conditions contribute
to the high CVD risk. The interviews will inform a follow-up survey of 350 PWH recruited from the same high-
risk clusters, to confirm syndemic conditions in a larger sample that could be addressed in future CVD
prevention efforts. Integrating quantitative and qualitative data sources, this study has great potential to inform
future comprehensive community- and health system-level interventions to reduce the CVD burden in PWH.
Terms: <AIDS Virus><Access to Care><Acquired Immune Deficiency Syndrome Virus><Acquired Immunodeficiency Syndrome Virus><Active Follow-up><Address><Age><Alcohol Chemical Class><Alcohols><Amino-terminal pro-brain natriuretic peptide><Anti-Retroviral Agents><Apoplexy><Atrial Fibrillation><Auricular Fibrillation><Biologic Factor><Biological><Biological Factors><Biological Markers><Biological Specimen Banks><Biological Substance Banks><Body Weight><Brain Vascular Accident><CVD prevention><Cardiac infarction><Cardiovascular><Cardiovascular Body System><Cardiovascular Diseases><Cardiovascular Organ System><Cardiovascular system><Cerebral Stroke><Cerebrovascular Apoplexy><Cerebrovascular Stroke><Cessation of life><Cognitive Discrimination><Communities><Coronary><Data><Data Sources><Death><Development><Discrimination><Disease><Disease Outcome><Disease Progression><Disorder><Disparities><Disparity><Dysfunction><Dyslipidemias><Economic Conditions><Economic Factors><Economical Conditions><Economical Factors><Electronic Health Record><Emotional><Enrollment><Evaluation><Event><Functional disorder><Future><GDF15><GDF15 gene><General Population><General Public><Geography><Goals><HIV><HIV Infections><HTLV-III Infections><HTLV-III-LAV Infections><Health><Health Care Systems><Health Services Accessibility><Health system><Healthcare Systems><Heart Vascular><Heart failure><High Prevalence><History><Homelessness><Human Immunodeficiency Viruses><Human T-Lymphotropic Virus Type III Infections><Inflammation><Insurance Benefits><Integrase><Intervention><Intervention Strategies><Interview><Joints><Knowledge><LAV-HTLV-III><Link><Lymphadenopathy-Associated Virus><MIC-1 gene product><MIC1><Macrophage Inhibitory Cytokine-1><Measures><Mental Depression><Mental Health><Mental Hygiene><Modeling><Morbidity><Morbidity - disease rate><Myocardial Infarct><Myocardial Infarction><N-BNP peptide><N-terminal pro-BNP><NAG-1 protein><NAG1><NSAID activated gene-1 product><NSAID-Activated Protein 1><NSAID-Regulated Protein 1><NT-BNP><NT-proBNP><Neighborhoods><Nonsteroidal Anti-Inflammatory Drug-Activated Protein 1><Obesity><Older Population><PLAB><PLAB Protein><PTGF-Beta><Patients><Peripheral arterial disease><Persons><Physiopathology><Placental Bone Morphogenic Protein><Placental TGF-Beta><Population><Preventative intervention><Prostate Differentiation Factor><Psychological Health><Public Health><Recording of previous events><Research><Research Resources><Resources><Risk><Risk Factors><Sampling><Smoking><Social Conditions><Social isolation><Societal Conditions><Stigmatization><Stroke><Substance Use Disorder><Survey Instrument><Surveys><Toxic effect><Toxicities><Trauma><Virus-HIV><Vulnerable Populations><Woman><access to health care><access to health services><access to healthcare><access to services><access to treatment><accessibility of health care><accessibility to health care><accessibility to health services><accessibility to healthcare><active followup><adiposity><ages><anti-retroviral><antiretroviral therapy><antiretroviral treatment><availability of services><bio-markers><biologic><biologic marker><biological specimen repository><biomarker><biosample repository><biospecimen bank><biospecimen repository><brain attack><burden of disease><burden of illness><cardiac disease prevention><cardiac failure><cardiac infarct><cardiovascular disease prevention><cardiovascular disease risk><cardiovascular disorder><cardiovascular disorder prevention><cardiovascular disorder risk><care access><care services><care systems><cerebral vascular accident><cerebrovascular accident><circulatory system><cohort><comparator group><comparison group><coronary attack><coronary infarct><coronary infarction><corpulence><depression><deprivation><design><designing><developmental><disease burden><disparities in treatment><disparity in care><disparity in healthcare><electronic health care record><electronic health medical record><electronic health plan record><electronic health registry><electronic medical health record><enroll><follow up><follow-up><followed up><followup><growth differentiation factor 15><health care access><health care availability><health care disparity><health care inequality><health care inequity><health care service access><health care service availability><health service access><health services availability><healthcare access><healthcare accessibility><healthcare availability><healthcare disparity><healthcare inequality><healthcare inequity><healthcare service access><healthcare service availability><heart attack><heart infarct><heart infarction><high risk><histories><homeless><housing instability><hypoimmunity><immune deficiency><immunodeficiency><inequality in treatment><inhibitor><instably housed><intervention for prevention><interventional strategy><marginalized group><marginalized individual><marginalized people><marginalized population><men><mortality><older groups><older individuals><older person><pathophysiology><peripheral artery disease><prevention intervention><preventional intervention strategy><preventive intervention><pro-brain natriuretic peptide (1-76)><proBNP(1-76)><recruit><response><revascularization><service availability><social><social factors><social relationships><social stigma><specimen bank><specimen repository><stigma><stroked><strokes><substance use><substance use and disorder><substance using><syndemic><synergism><synergistic epidemic><treatment access><treatment disparity><treatment inequality><treatment inequity><unhoused><unstable housing><unstably housed><vulnerable group><vulnerable individual><vulnerable people>