iconstar paper   HIV Articles  
Back grey arrow rt.gif
HIV Increases Risk for Heart Disease; Nadir CD4 & Heart Disease in HIV
  Download the PDF here
(1) "nadir CD4 but not recent CD4, was independently associated with MIs among HIV+ individuals, suggesting the higher MI risk in this population may not be easily reversible"......argue for increased efforts to diagnose and treat HIV as early as possible, which if combined with aggressive traditional CVD risk factor management, might result in a similar MI burden as the general population"
(2) "50% Increased Risk for Myocardial Infarction (MI) Rate in HIV+ in Veterans Cohort (VACS)" Journal of Internal Medicine 2013 "recent HIV-1 RNA of at least 500 copies/mL (HR, 1.60; 95% CI, 1.14-2.22) and recent CD4 cell count less than 200 cells/mL (1.57; 1.10-2.24) were associated with AMI (acute myocardial infarction) http://www.natap.org/2013/HIV/031113_01.htm
(3) CROI 2011, Silverberg/Kaiser: Contribution of Immunodeficiency to Coronary Heart Disease: Cohort Study of HIV-infected and HIV-uninfected Kaiser Permanente Members CD4 nadir <200 is a risk factor in this study http://www.natap.org/2011/CROI/croi_114.htm


JAIDS Oct 1 (CROI Study): Immunodeficiency and Risk of Myocardial Infarction among HIV-positive Individuals with Access to Care Silverberg, Michael J. PhD, MPH et al.
(1) "Our current findings demonstrate a 44% increased risk of MIs among HIV+ subjects compared with HIV- subjects from the same healthcare care setting, independent of traditional CVD risk factors such as smoking, male sex, older age, hyperlipidemia and hypertension"
(2) nadir CD4 but not recent CD4, was independently associated with MIs among HIV+ individuals, suggesting the higher MI risk in this population may not be easily reversible
(3) "Among HIV+ subjects, nadir CD4 was the only HIV-specific factor associated with MIs (RR per 100 cells=0.88; 95% CI=0.81-0.96)....Compared with HIV- subjects (reference), MI rates were similar for HIV+ subjects with recent CD4>=500 cells/[micro]L (RR=1.18; 95% CI=0.96-1.45) and those with nadir "CD4>=500 cells" HIV+ subjects with recent CD4<200/μL had an adjusted RR=1.76 (95% CI= 1.31-2.37) for MIs compared with HIV- subjects, while no association was observed comparing HIV+ subjects with CD4≥500/μL with HIV- subjects (RR=1.18, 95% CI= 0.96-1.45) (p-trend=0.03). Similarly, HIV+ subjects with nadir CD4<200/μL had an adjusted RR=1.74 (95% CI=1.47-2.06) compared with HIV- subjects, but those with nadir CD4≥500/μL had an adjusted RR=0.85 (95% CI= 0.55-1.33) (p-trend=0.002)."
"The increased risk of MIs among HIV+ patients was established early in the ART era, including an early report from our cohort.6 However, it was unclear how much of the increased risk was influenced by confounding factors, including smoking, socioeconomic factors and access to medical care. Here we evaluated MI risk in a large population of HIV+ and HIV subjects identified from the same healthcare setting, thus reducing disparities with respect to access to care. We also adjusted for smoking, race/ethnicity and census-based SES to further adjust for potential key confounders."
"The strong observed associations for nadir CD4 and MI risk likely reflects the fact that it is a better surrogate than recent CD4 for increased duration of immunosuppression and HIV-associated inflammation. Alternatively, any potential direct toxic effects of specific ART such as PI-based ART may have masked protective effects of recent CD4. However, a sensitivity analysis that excluded those treated with PIs indicated that recent CD4 was still not protective against MIs (data not shown)."

  iconpaperstack View Older Articles   Back to Top   www.natap.org