Immunodeficiency and risk of myocardial infarction among HIV-positive individuals with access to care.
BACKGROUND
We sought to clarify the association of HIV infection and immunodeficiency on myocardial infarction (MI) risk.


METHODS
We conducted a cohort study from 1996 to 2009 of HIV-positive (HIV) and demographically matched HIV-negative (HIV) Kaiser Permanente California health plan members. Rate ratios (RRs) were obtained from Poisson regression models comparing MI incidence rates between HIV (overall and stratified by recent and nadir CD4 count, and recent HIV RNA levels) and HIV subjects, adjusting for age, sex, calendar era, race/ethnicity, census-based socioeconomic status, smoking, alcohol/drug abuse, overweight/obesity, diabetes, hypertension, and lipid-lowering therapy. Among HIV subjects, we also evaluated the independent association of CD4, HIV RNA, and antiretroviral therapy (ART) use.


RESULTS
The study population included 22,081 HIV and 230,069 HIV subjects. The crude MI incidence rate per 100,000 person-years was 283 and 165 for HIV and HIV subjects, respectively, with an adjusted RR of 1.4 [95% confidence interval (CI): 1.3 to 1.6]. Compared with HIV subjects (reference), MI rates were similar for HIV subjects with recent CD4 ≥500 cells per microliter (RR = 1.18; 95% CI: 0.96 to 1.45) and those with nadir CD4 ≥500 cells per microliter (RR = 0.85; 95% CI: 0.55 to 1.33). Among HIV subjects, nadir CD4 was the only HIV-specific factor associated with MIs (RR per 100 cells = 0.88; 95% CI: 0.81 to 0.96), whereas recent CD4 and HIV RNA, prior ART use, and duration of protease inhibitors and nonnucleoside reverse transcriptase inhibitors were not associated with MIs.


CONCLUSIONS
HIV subjects with recent or nadir CD4 ≥500 cells per microliter had similar MI rates compared with HIV subjects. Lower nadir CD4, in particular, seems to be independently associated with MIs. These results strengthen recommendations for earlier ART initiation.
*Division of Research, Kaiser Permanente Northern California, Oakland, CA; †Department of Research and Evaluation, Kaiser Permanente South California, Pasadena, CA; ‡Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, MD; §Division of Infectious Diseases, Department of Internal Medicine, Kaiser Permanente Southern California, Los Angeles, CA; and ‖Division of Infectious Diseases, Kaiser Permanente Northern California, Hayward, CA.
Michael J
MJ
Silverberg
Wendy A
WA
Leyden
Lanfang
L
Xu
Michael A
MA
Horberg
Chun R
CR
Chao
William J
WJ
Towner
Leo B
LB
Hurley
Charles P
CP
Quesenberry
Daniel B
DB
Klein
D000328:Adult; D000368:Aged; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D002140:California / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000276:immunology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology*; D018570:Risk Assessment; D019562:Viral Load; D055815:Young Adult
D044966:Anti-Retroviral Agents