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Kidney Disease Key Cofactor in Coronary Artery
Disease Risk With HIV at 60 and Older
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5th International Workshop on HIV and Aging. October 20-21, 2014. Baltimore
Mark Mascolini
HIV infection almost tripled chances of coronary artery disease (CAD) in a comparison of 1253 Delaware residents at least 60 years old with and without HIV--but only among people who had chronic kidney disease (CKD) [1]. Women with CKD had a 70% lower chance of CAD than men.
Clinical researchers at the Christiana Care Health System in Wilmington noted that noninfectious comorbidities account for a growing proportion of deaths among people with HIV in North America and Europe [2]. They conducted this retrospective analysis of HIV-positive and negative patients to compare rates of eight noninfectious non-AIDS comorbidities and to determine whether CKD, defined as glomerular filtration rate below 60 mL/min, affects CAD risk.
The chart review included 1253 patients, 100 of them with HIV, seen from April 2011 through February 2013 at two urban office practices in Delaware. Everyone was 60 or older. The HIV office offers comprehensive HIV care and receives Ryan White funding. The other office specializes in primary care internal medicine. The research team considered diagnoses of eight noninfectious non-AIDS comorbidities: CAD, CKD, hypertension, diabetes, hyperlipidemia, malignancies, depression, and other psychiatric diagnoses.
The Delaware team noted that CKD, diabetes, hypertension, and dyslipidemia directly affect CAD risk, and HIV directly affects CKD risk. The impact of hypertension and diabetes on CAD risk may be mediated by CKD. To determine whether HIV affects CAD risk in the context of these comorbidities, they used logistic regression adjusted for the other comorbidities and stratified by CKD status.
The HIV group averaged 65.8 years in age, compared with 68.4 years in the HIV-negative group. Proportions of men and women were 58% and 42% with HIV and 39% and 61% without HIV. Racial/ethnic distributions in the HIV group were 78% black, 15% white, and 7% Hispanic, compared with 53% black, 27% white, 4% Hispanic, and 16% other in the comparison group.
Prevalence of five comorbidities was significantly higher with than without HIV:
-- CAD: 24% versus 16%, P = 0.038
-- CKD: 36% versus 7%, P < 0.001
-- Malignancies: 20% versus 12%, P = 0.026
-- Depression: 32% versus 22%, P = 0.021
-- Other psychiatric diagnoses: 27% versus 17%, P = 0.016
Hypertension prevalence was high in both groups but significantly lower in people with than without (66% versus 81%, P < 0.001). Rates of hyperlipidemia and diabetes did not differ between the two groups.
When the Delaware team divided participants into those with and without CKD, logistic regression analysis determined that HIV infection nearly tripled odds of CAD in people with CKD (odds ratio [OR] 2.892, 95% confidence interval [CI] 1.058 to 7.906, P = 0.038) but not in people without CKD (OR 1.207, 95% CI 0.570 to 2.554, P = 0.623). Among people with CKD, female gender lowered odds of CAD more than 70% (OR 0.279, 95% CI 0.117 to 0.665, P = 0.004). An independent association between female gender and lower CAD odds also held true in people without CKD (OR 0.454, 95% CI 0.321 to 0.643, P < 0.0001).
No other variables, including age, affected chances of CAD in people with CKD. In people without CKD, older age, hypertension, and hyperlipidemia also boosted odds of CAD.
The investigators noted that their analysis is limited by the low number of people with HIV and by the possible impact of abacavir--which got prescribed more for people with than without CKD--on CAD risk. With those limitations in mind, they proposed that "HIV is associated with CAD only in the presence of CKD."
References
1. Szabo Preininger S, Ewen E, et al. The influence of HIV infection on non-infectious comorbidities in an aging cohort. 5th International Workshop on HIV and Aging. October 20-21, 2014. Baltimore. Abstract 16.
2. Antiretroviral Therapy Cohort Collaboration. Causes of death in HIV-1-infected patients treated with antiretroviral therapy, 1996-2006: collaborative analysis of 13 HIV cohort studies. Clin Infect Dis. 2010;50:1387-1396. http://cid.oxfordjournals.org/content/50/10/1387.long
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