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


The study population consisted of 1980 patients with median follow-up of 10.9 years. The median start of observation was in 2005. Mean age was 41.9 years, 73% were male, and 50% were Caucasian. Hypertension was present in 16%, dyslipidaemia in 17%, diabetes mellitus in 8%, heart failure in 2%, and peripheral vascular disease in 1%; 42% were smokers. Mean CD4 count was 506.3 ± 307.1 cells/μL, 48% of all included patients had an HIV VL < 400 copies/mL, and 87% were on ART. Mean length of time on ART was 3.4 ± 3.8 years before the date of baseline AMC. Mean nadir CD4 count before baseline was 280 ± 260.4 cells/μL. The median (range) of monocyte values used to generate the baseline monocyte count was 6 (1–166). The mean WBC was 5.66 ± 1.55 × 103/μL, and mean AMC was 0.38 ± 0.13 × 103/μL. There was no difference in intra-individual variance in AMC between those who did have CVEs and those who did not. There was no difference in the level of medication use by quartile of AMC for any class of ART medications [protease inhibitors (PIs), P = 0.7165; nucleoside reverse transcriptase inhibitors (NRTIs), P = 0.2081; non-NRTIs (NNRTIs), P = 0.065].

A total of 182 patients had a CVE; 89 developed an acute MI, four of which were fatal, and 93 developed a non-fatal acute ischaemic stroke. Individuals with events were significantly more likely to be older, to have hypertension, dyslipidaemia, diabetes mellitus and heart failure, and to be current smokers. Those with events also had a significantly lower CD4 cell count, were more likely to be on PIs, less likely to be on integrase strand transfer inhibitors (INSTIs), and more likely to be co-infected with hepatitis C virus (HCV). (Table 1).

In univariate analysis, there was no association between AMC and incident CVE [Q2 hazard ratio (HR) = 0.96, 95% CI: 0.64–1.44, P = 0.83; Q3 HR = 1.08, 95% CI: 0.72–1.61, P = 0.71; and Q4 HR = 1.16, 95% CI: 0.76–1.76, P = 0.50 vs. Q1]. In multivariable modelling adjusted for age, sex, CD4 cell count (per 100 cells/μL increments), diabetes mellitus, smoking status, statin use and HIV VL, Q2 AMC (HR = 1.01, P = 0.98), Q3 (HR = 1.07, P = 0.76) and Q4 (HR = 0.97, P = 0.89) were not significantly associated with CVE compared with Q1 AMC. (Table 2). Analysis of AMC and of monocyte percentage as continuous variables yielded similar results (data not shown). The most recent AMC prior to CVE also did not show any association with future CVEs (data not shown). Traditional risk factors for cardiovascular disease such as age (HR = 1.05, P < 0.0001), diagnosis of diabetes mellitus (HR = 3.02, P < 0.0001) and tobacco use (HR = 1.99, P < 0.0001) were significantly associated with CVE. CD4 cell count (per 100 cells/μL increments) (HR = 0.93, P = 0.01) was also associated with CVE while HIV VL was not (HR = 1.00, P = 0.98).

In additional models, we added time on ART before baseline and nadir CD4 cell count before baseline individually and together, and the inclusions of these variables did not significantly alter the association of AMC with CVE (data not shown).