Utilization of Absolute Monocyte Counts to Predict Cardiovascular Events in People Living With HIV

M Bogorodskaya; A Lyass; TF Mahoney; LH Borowsky; P Sen; FK Swirski; S Srinivasa; CT Longenecker; JM Massaro; RB D'Agostino Sr.; VA Triant


HIV Medicine. 2021;22(4):314-320. 

In This Article

Abstract and Introduction


Objectives: Cardiovascular risk is increased in people living with HIV (PLWH). In HIV-uninfected populations, total absolute monocyte count (AMC) has been shown to be predictive of future cardiovascular events (CVEs). We sought to determine whether AMC predicts CVEs in PLWH independent of established and HIV-related cardiovascular risk factors.

Methods: We identified all PLWH within the Partners HIV Cohort without factors that could confound the monocyte count. CVE was defined as fatal or non-fatal acute myocardial infarction or ischaemic stroke. Baseline-measured AMC was defined as the average of all outpatient AMC counts a year before and after the baseline date. Multivariable Cox proportional hazards models were used to assess the association of baseline AMC with CVEs.

Results: Our cohort consisted of 1980 patients, with median follow-up of 10.9 years and 182 CVEs. Mean (± SD) age was 41.9 ± 9.3 years; 73.0% were male. Mean CD4 count was 506.3 ± 307.1 cells/μL, 48% had HIV viral load (VL) < 400 copies/mL, and 87% were on antiretroviral therapy. Mean AMC was 0.38 × 103 ± 0.13 cells/μL. In multivariable modelling adjusted for traditional CV risk factors, CD4 cell count, and HIV VL, AMC quartile 2 (Q2) (HR = 1.01, P = 0.98), Q3 (HR = 1.07, P = 0.76), and Q4 (HR = 0.97, P = 0.89) were not significantly predictive of CVE compared with Q1.

Discussion: Baseline AMC was not associated with long-term CVEs in PLWH. AMC obtained in routine clinical encounters does not appear to enhance CV risk stratification in PLWH.


With significant advances in antiretroviral therapy (ART) over the last three decades, people living with HIV (PLWH) are living longer[1] and developing age-associated, chronic, non-communicable disorders such as cardiovascular disease (CVD).[2,3] In previous studies, HIV has been found to be an independent risk factor for myocardial infarction (MI) and acute ischaemic stroke,[4,5] even after adjustment for viral load (VL), ART and CD4 cell count. The mechanism of this phenomenon is thought to be a complex interplay of increased prevalence of traditional risk factors,[6] HIV-related factors,[7] and the combination of increased microbial gut translocation and continued HIV replication that leads to ongoing chronic inflammation and immune dysregulation.[8–10] The chronic inflammation in PLWH and its relationship to CVD is thought to be partially mediated by monocytes.[8,11–13]

Thus far, research on the involvement of monocytes in the development of CVD in PLWH has focused on biomarkers that are difficult to incorporate into clinical management given their expense and lack of clinical availability. Previous studies in uninfected individuals have shown that higher absolute monocyte counts (AMCs) can predict cardiovascular events (CVEs)[14,15] as well as 30-day mortality after emergency department visits.[16] This study sought to determine whether AMC predicts incident CVEs in PLWH independently of established CVD risk factors and HIV-related parameters.