title: Acute coronary syndromes in human immunodeficiency virus patients: a meta-analysis investigating adverse event rates and the role of antiretroviral therapy.
abstract: OBJECTIVE
  Highly active antiretroviral therapy (HAART) dramatically reduces human immunodeficiency virus (HIV)-associated morbidity and mortality, but adverse effects of HAART are becoming an increasing challenge, especially in the setting of acute coronary syndromes (ACS). We thus performed a comprehensive review of studies focusing on ACS in HIV patients.
  
  
  RESULTS
  MEDLINE/PubMed was systematically screened for studies reporting on ACS in HIV patients. Baseline, treatment, and outcome data were appraised and pooled with random-effect methods computing summary estimates [95% confidence intervals (CIs)]. A total of 11 studies including 2442 patients were identified, with a notably low prevalence of diabetes [10.86 (4.11, 17.60); 95% CI]. Rates of in-hospital death were 8.00% (2.8, 12.5; 95% CI), ascribable to cardiovascular events for 7.90% (2.43, 13.37; 95% CI), with 2.31% (0.60, 4.01; 95% CI) developing cardiogenic shock. At a median follow-up of 25.50 months (11.25, 42; 95% CI), no deaths were recorded, with an incidence of 9.42% of acute myocardial infarction (2.68, 16.17; 95% CI) and of 20.18% (9.84, 30.51; 95% CI) of percutaneous coronary revascularization. Moreover, pooled analysis of the studies reporting incidence of acute myocardial infarction in patients exposed to protease inhibitors showed an overall significant risk of 2.68 (odds ratio 1.89, 3.89; 95% CI).
  
  
  CONCLUSIONS
  Human immunodeficiency virus patients admitted for ACS face a substantial short-term risk of death and a significant long-term risk of coronary revascularization and myocardial infarction, especially if receiving protease inhibitors.
authors.affiliation: Division of Cardiology, University of Turin, S. Giovanni Battista 'Molinette' Hospital, Corso Bramante 88-90, Turin 10126, Italy. fabrizio.dascenzo@gmail.com
authors.forename: Fabrizio
authors.initials: F
authors.lastname: D'Ascenzo
authors.forename: Enrico
authors.initials: E
authors.lastname: Cerrato
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Biondi-Zoccai
authors.forename: Claudio
authors.initials: C
authors.lastname: Moretti
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Omedè
authors.forename: Filippo
authors.initials: F
authors.lastname: Sciuto
authors.forename: Mario
authors.initials: M
authors.lastname: Bollati
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Modena
authors.forename: Fiorenzo
authors.initials: F
authors.lastname: Gaita
authors.forename: Imad
authors.initials: I
authors.lastname: Sheiban
mesh_terms: D054058:Acute Coronary Syndrome / Q000139:chemically induced*; D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data; D019380:Anti-HIV Agents / Q000009:adverse effects*; D004812:Epidemiologic Methods; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D017320:HIV Protease Inhibitors / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000139:chemically induced; D011379:Prognosis
chemical_list: D019380:Anti-HIV Agents; D017320:HIV Protease Inhibitors