{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T02:11:37Z","timestamp":1787019097744,"version":"build-2736575974"},"reference-count":45,"publisher":"SAGE Publications","issue":"9","license":[{"start":{"date-parts":[[2025,8,26]],"date-time":"2025-08-26T00:00:00Z","timestamp":1756166400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["AIDS Patient Care and STDs"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:p>\n                    People living with HIV (PLWH) continue to experience longer life expectancy due to effective antiretroviral therapy (ART). However, cardiovascular disease (CVD) has become a leading cause of morbidity and mortality. Despite improved HIV care, major adverse cardiovascular events (MACE) remain prevalent, with limited data from long-term cohorts. This study aimed to determine the incidence, risk factors, and predictors of MACE in long-term ACTHIV-IST cohort of PLWH in Istanbul. We conducted a retrospective analysis of 1059 patients followed for at least 10 years. Patients with prior MACE or noncardiac mortality were excluded. Traditional CVD risk factors, HIV-related immunovirological parameters, ART, and comorbidities were analyzed using Cox proportional hazards regression. MACE incidence was 7.55% (80\/1059) with a cumulative rate of 11.1%. The most frequent events were ischemic heart disease (30.4%), myocardial infarction (27.6%), and sudden cardiac death (18.6%). Among those without traditional CVD risk factors, a CD4\n                    <jats:sup>+<\/jats:sup>\n                    count &lt;200 cells\/mm\n                    <jats:sup>3<\/jats:sup>\n                    at diagnosis was associated with a 4.5-fold increased MACE risk. Hypertension (hazard ratio [HR]: 4.74), coronary artery disease (CAD) (HR: 8.49), and older age at HIV diagnosis (HR: 1.031\/year) were the strongest independent predictors (\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    &lt; 0.05). Patients who should have used statins but did not were at higher risk of developing MACE (34% vs. 17%) compared to those who did (\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    &lt; 0.05). Twenty-one statin users of those who had MACE were before the event. A significantly higher MACE rate was observed in patients who used protease inhibitor (PI) compared to those who did not (\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    = 0.002). Low baseline CD4\n                    <jats:sup>+<\/jats:sup>\n                    T-cell count, prolonged HIV duration, comorbidities (e.g., hypertension, CAD, and dyslipidemia), PI experienced, and older age at HIV diagnosis significantly increase MACE risk. Early diagnosis, continuous cardiovascular monitoring, start statins if indicated, and individualized ART strategies are essential to reduce MACE-related morbidity and mortality in PLWH.\n                  <\/jats:p>","DOI":"10.1177\/10872914251359817","type":"journal-article","created":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T06:06:43Z","timestamp":1761199603000},"page":"342-352","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Risk Factors for Major Adverse Cardiovascular Events in Antiretroviral Therapy-Treated People with HIV: A Long-Term Cohort Study in Turkey"],"prefix":"10.1177","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0392-229X","authenticated-orcid":false,"given":"Ceren","family":"Atasoy Tahtasakal","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases, Health Sciences University Sisli Hamidiye Etfal Training and Researching Hospital, Istanbul, Turkey."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dilek","family":"Y\u0131ld\u0131z Sevgi","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Health Sciences University Sisli Hamidiye Etfal Training and Researching Hospital, Istanbul, Turkey."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sibel","family":"Y\u0131ld\u0131z Kaya","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Department of Infectious Diseases, Istanbul University Cerrahpa\u015fa, Istanbul, Turkey."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Z\u00fchal","family":"Ye\u015filba\u011f","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Health Sciences University Taksim Training and Researching Hospital, Istanbul, Turkey."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u0130nci","family":"Y\u0131lmaz Nakir","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Health Sciences University \u0130stanbul Haseki Training and Researching Hospital, Istanbul, Turkey."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alper","family":"G\u00fcnd\u00fcz","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Okan","family":"Derin","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Health Sciences University Sisli Hamidiye Etfal Training and Researching Hospital, Istanbul, Turkey."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bilg\u00fcl","family":"Mete","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Department of Infectious Diseases, Istanbul University Cerrahpa\u015fa, Istanbul, Turkey."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahsen","family":"\u00d6nc\u00fcl","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Health Sciences University Sisli Hamidiye Etfal Training and Researching Hospital, Istanbul, Turkey."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hayat Kumbasar","family":"Karaosmano\u011flu","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Health Sciences University Taksim Training and Researching Hospital, Istanbul, Turkey."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esra","family":"Zerdali","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Health Sciences University \u0130stanbul Haseki Training and Researching Hospital, Istanbul, Turkey."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fehmi","family":"Tabak","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Department of Infectious Diseases, Istanbul University Cerrahpa\u015fa, Istanbul, Turkey."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"ACTHIV-IST Study Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,8,26]]},"reference":[{"key":"e_1_3_5_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)61809-7"},{"key":"e_1_3_5_3_2","unstructured":"Full report \u2014 In Danger: UNAIDS Global AIDS Update 2022 | UNAIDS. 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