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Lower CD4 Count, Detectable Viral Load, & Traditional CVD Risk Factors are Associated with Increased Risk of Primary Myocardial Infarction in the CNICS cohort....IDU associated with secondary MI
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Reported by Jules Levin
CROI 2014 March 3-6 Boston, MA
DR Drozd1, RM Nance1, JAC Delaney1, GA Burkholder2, WC Mathews3, RD Moore4, JJ Eron5, PW Hunt6, MM Kitahata1, HM Crane1
for the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) Cohort
1 University of Washington, Seattle, WA, USA; 2 University of Alabama at Birmingham, Birmingham, AL, USA; 3 University of California, San Diego, San Diego, CA, USA; 4 Johns Hopkins University, Baltimore, MD, USA; 5 University of North Carolina, Chapel Hill, NC, US; 6 University of California, San Francisco, San Francisco, CA, USA
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"total and HDL cholesterol, and SBP were significant predictors of incident MI......each 300 cell/mm3 increase in current CD4 count was associated with a 25% decrease in the risk of MI, and higher HIV viral load was associated with a significant increase in MI risk....Injection drug and tobacco use, older age, black race.....and stage 4-5 CKD (kidney disease) were associated with secondary MIs.......significantly increased risk of primary MIs when comparing individuals at CD4 count <100 to those with a CD4 ≥100. There is a trend toward decreasing risk at higher CD4 strata, but they do not reach significance.....detectable viral load was associated with increased risk in the higher CD4 strata."
Program Abstract
Background: There is increasing evidence that cardiovascular disease (CVD) is more common among persons living with HIV (PLWH) than among
HIV-negative individuals. However, most previous studies have been limited by small sample size, lack of well-defined clinical events, incomplete case
ascertainment, and the use of composite endpoints. We examined which traditional CVD risk factors and HIV-specific factors predict myocardial infarction
(MI) in PLWH.
Methodology: CNICS is a multi-center cohort comprised of 8 clinical sites contributing comprehensive clinical data on >27,000 HIV patients followed
during routine care. We developed a state-of-the-art screening algorithm and central adjudication protocol for the validation of incident MIs. Among 18,115
eligible participants, we found 1360 individuals with potential incident MIs, of which 314 were confirmed as incident MIs. We used logistic regression to
estimate risk of MI associated with baseline Framingham risk score (FRS) covariates (total and HDL cholesterol, systolic blood pressure (SBP), age, sex,
diabetes, and smoking) and HIV factors (current CD4, HIV viral load, and transmission risk of injection drug use).
Results: In multivariate analysis the Framingham covariates smoking, age, total and HDL cholesterol, and SBP were significant predictors of incident MI.
Diabetes and IDU were not significant. After adjusting for traditional CVD risk factors, each 300 cell/mm3 increase in current CD4 count was associated
with a 25% decrease in the risk of MI, and higher HIV viral load was associated with a significant increase in MI risk. Median time between last measured
CD4 count and end of follow-up due to event or administrative censoring was 84 days (IQR: 30-172 days).
Conclusions: While FRS covariates remain important, HIV-specific factors are also significantly associated with incident MI in PLWH. Higher prevalence
of IDU among females likely confounds the effect of male sex. After adjusting for traditional CVD risk factors, the most recent CD4 count and HIV viral load prior to the event were independent predictors of MI incidence. Our findings highlight the importance of early and effective treatment for PLWH and provide additional evidence, based on a rigorously adjudicated clinical endpoint (MI), that immunodeficiency and active viral replication may be associated with the excess CVD risk in PLWH.
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