title: Associations between immune depression and cardiovascular events in HIV infection.
abstract: OBJECTIVE
  To consider associations between the latest/nadir CD4 cell count, and time spent with CD4 cell count less than 200 cells/μl (duration of immune depression), and myocardial infarction (MI), coronary heart disease (CHD), stroke, or cardiovascular disease (CVD) (CHD or stroke) in 33 301 HIV-positive individuals.
  
  
  METHODS
  Longitudinal cohort study.
  
  
  METHODS
  Analyses were undertaken using Poisson regression. To investigate whether analyses of stroke were robust to the type of endpoint, we additionally included stroke-like events and rejected strokes into the stroke endpoint.
  
  
  RESULTS
  Participants experienced 716 MI, 1056 CHD, 303 stroke, and 1284 CVD events. Whereas there was no evidence of a higher MI/CHD risk in those with lower latest/nadir CD4 cell counts after adjustment [current CD4 <100 cells/μl: relative rate (95% confidence interval) 0.96 (0.62-1.50) for MI, 0.89 (0.30-2.36) for CHD; nadir CD4 <100 cells/μl: 1.36 (0.57-3.23) for MI, 0.98 (0.45-2.16) for CHD], stroke and CVD rates were higher in those with a latest CD4 cell count less than 100 cells/μl [2.26 (1.29-3.94) and 1.14 (0.84-1.56), respectively]. All events occurred less frequently in those who had not experienced immune depression, although evidence for a linear association with duration of immune depression was weak. The association between stroke risk and the latest CD4 cell count strengthened as stroke-like and rejected strokes were included; conversely, associations with established stroke risk factors weakened.
  
  
  CONCLUSIONS
  We do not find strong evidence that HIV-positive individuals with a low CD4 cell count are more likely to experience MI/CHD. Although strokes appear to occur more commonly at low CD4 cell counts, this may be partly explained by misclassification or other biases.
authors.affiliation: aResearch Department of Infection and Population Health, UCL, London, UK bCopenhagen HIV Programme, University of Copenhagen, Copenhagen, Denmark cDepartment of Infectious Diseases, CHU Saint-Pierre Hospital, Brussels, Belgium dDivision of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland eHospital San Paolo, University of Milan, Milan, Italy fAcademic Medical Center, and Stichting HIV Monitoring, Amsterdam, The Netherlands gICAP-Columbia University/Harlem Hospital, New York, USA hDépartement de Santé Publique, Centre Hospitalier Universitaire, Nice iINSERM, Centre INSERM U897 'Epidémiologie et Biostatistique' jUniversité Bordeaux Segalen, Institut de Santé Publique Epidémiologie Développement (ISPED), Bordeaux, France kKirby Institute, University of New South Wales, Sydney, Australia lEpidemiklinikken M5132, Copenhagen University Hospital/Rigshospitalet, Copenhagen, Denmark. *See Acknowledgements section for full listing of study group.
authors.forename: Caroline A
authors.initials: CA
authors.lastname: Sabin
authors.forename: Lene
authors.initials: L
authors.lastname: Ryom
authors.forename: Stephane
authors.initials: S
authors.lastname: De Wit
authors.forename: Amanda
authors.initials: A
authors.lastname: Mocroft
authors.forename: Andrew N
authors.initials: AN
authors.lastname: Phillips
authors.forename: Signe W
authors.initials: SW
authors.lastname: Worm
authors.forename: Rainer
authors.initials: R
authors.lastname: Weber
authors.forename: Antonella
authors.initials: A
authors.lastname: D'Arminio Monforte
authors.forename: Peter
authors.initials: P
authors.lastname: Reiss
authors.forename: David
authors.initials: D
authors.lastname: Kamara
authors.forename: Wafaa
authors.initials: W
authors.lastname: El-Sadr
authors.forename: Christian
authors.initials: C
authors.lastname: Pradier
authors.forename: Francois
authors.initials: F
authors.lastname: Dabis
authors.forename: Matthew
authors.initials: M
authors.lastname: Law
authors.forename: Jens
authors.initials: J
authors.lastname: Lundgren
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018791:CD4 Lymphocyte Count; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000276:immunology*; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D055815:Young Adult