Cardiovascular disease has become a leading contributor to deaths among people with HIV in the United States, according to a 26-year national analysis presented at IDWeek 2026.
The study, led by Sara Rahman, MBBS, of the Services Institute of Medical Sciences in Lahore, Pakistan, examined trends in cardiovascular disease-related deaths among people with HIV from 1999 to 2024. Researchers also compared these trends with deaths associated with opportunistic infections, historically a major contributor to deaths among people with HIV.
Using the CDC WONDER database, researchers identified 279,207 deaths attributed to HIV during the study period. Cardiovascular disease was associated with 27% of these deaths, making it the second most common contributor after opportunistic infections, which accounted for 32%.
The proportion of deaths associated with cardiovascular disease increased from 9.3% in 2000 to 46.5% in 2024. Researchers identified a particularly rapid increase from 2001 to 2004, with an annual percentage change of 44.2%, followed by a sustained annual increase of 3.8% from 2004 to 2024. Cardiovascular disease surpassed opportunistic infections as a contributor to deaths in 2018, reflecting a shift in the health challenges facing people with HIV.
The analysis also revealed demographic and geographic differences. Cardiovascular disease was the leading contributor to deaths among people with HIV aged 45 and older, while opportunistic infections accounted for a greater proportion of deaths among younger people.
Although the overall analysis did not identify statistically significant racial or ethnic differences, trends in cardiovascular disease-related deaths varied across populations. Annual percentage changes were 4% among White individuals and 3.8% among African American individuals, compared with 2.61% among Hispanic individuals. Hispanic individuals were also the only subgroup to show an increasing trend in deaths associated with opportunistic infections.
Geographically, cardiovascular disease-related deaths increased across most states, with the greatest increases observed in the southeastern United States.
Although effective antiretroviral therapy has transformed HIV into a manageable chronic condition for many people, the researchers noted the need to address cardiovascular health alongside continued HIV treatment. They concluded that HIV care should incorporate comprehensive cardiovascular risk assessment and prevention strategies, with particular attention to older adults and populations experiencing disproportionate increases in cardiovascular disease-related deaths.
The researchers reported no financial relationships to disclose for this presentation.