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CD4+ T-cell Counts < 350 cells/mm3 Are a Risk Factor for Cardiovascular Disease in the HIV Outpatient Study (HOPS)
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Reported by Jules Levin
IAC Mexico City Aug 3-8 2008
KA Lichtenstein1, K Buckner1, C Armon2, EM Tedaldi3, JS Chmiel4,
KC Wood2, K Buchacz5, SD Holmberg5, JT Brooks5,
and the HOPS Investigators
1National Jewish Health, Denver, CO; 2Cerner Corporation, Vienna, VA; 3Temple University, Philadelphia, PA; 4Northwestern University, Chicago, IL; 5Centers for Disease Control and Prevention, Atlanta, GA
"Conclusion: CD4+ cell counts < 350 cells/mm3 are an independent risk factor for incident CVD in the HOPS cohort."
ABSTRACT
Background: Traditional cardiovascular disease (CVD) risk factors are associated with incident CVD in HIV-infected patients. HIV infection and treatment are also implicated.
Methods: We evaluated HOPS participants active after 12/31/01, with >2 office visits, >2 blood pressure (BP) determinations, and >1 fasting lipid panel measured from baseline (within -12/+9 months). We followed patients until 6/30/07, death, or last office visit and calculated rates of incident CVD events (i.e. myocardial infarction, coronary artery disease, peripheral vascular disease, transient ischemic attack, angina, aortic aneurysm, coronary artery bypass, or angioplasty). Using National Cholesterol Education Program-based IDSA/ACTG guidelines we categorized patients into four risk categories from low risk to highest risk, and compared risk group, injection drug use, baseline CD4+ cell count, viral load, and use of antiretroviral agents as time-dependent variables (protease inhibitors, "d-drugs" [d4T, ddI, ddC], zidovudine, abacavir and HAART) for their association with incident CVD in a Cox proportional hazard model.
Results: Of 1,697 HOPS patients, 557 (32.8%) had 0-1 risk factor. In patients with >2 risk factors 470 (27.7%) had a 10-yr cardiovascular risk <10%, 322 (19.0%) had a risk of 10-20%, and 348 (20.5%) had a risk >20% (Table 1) with CVD incidence per 100 person-years of 0.4, 1.0, 2.2, and 3.7, respectively. Median years on NA, NNRTI, PI, zidovudine, abacavir, d-drug and HAART agents were not significantly different within each risk category (Table 2).
In the multivariate analysis, CVD risk group, and baseline CD4+ cell count <350 cells/mm3 were independently associated with incident CVD (p-value <0.05) (Figure 1). CD4+ cell count < 350 cells/mm3 remained independently associated with incident CVD when adjusting for individual traditional CVD risk factors (Figure 2).
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