Key result
HIV infection was not associated with an increased risk of recurrent ACS within three years compared to HIV-uninfected individuals (HR 1.08, 95% CI 0.76-1.54).
Why the study?
Does HIV infection increase the risk of recurrent acute coronary syndrome in adults surviving an initial ACS hospitalization?
Cohort (n=86,547)
Does HIV infection increase the risk of recurrent acute coronary syndrome in adults surviving an initial ACS hospitalization?
Hazard Ratio: 1.08 (95% CI 0.76–1.54)
Absolute Event Rate: 15% vs 16%
p-value: p=0.42
HIV patients surviving an initial ACS event do not have a higher risk of recurrent ACS than uninfected patients, though those with severe immunodeficiency face significantly higher all-cause mortality.
Recurrent ACS risk similar in HIV-infected and uninfected survivors; leaves open targeted approaches to reduce excess mortality in low-CD4 patients.
OBJECTIVES: We evaluated the association of HIV infection and immunodeficiency with acute coronary syndrome (ACS) recurrence, and with all-cause mortality as a secondary outcome, after hospitalization for ACS among HIV-infected and HIV-uninfected individuals. METHODS: We conducted a retrospective cohort study within Kaiser Permanente Northern California of HIV-infected and HIV-uninfected adults discharged after ACS hospitalization [types: ST-elevation myocardial infarction (STEMI), non-STEMI, or unstable angina] during 1996-2010. We compared the outcomes of ACS recurrence and all-cause mortality within 3 years, both overall by HIV status and stratified by recent CD4 count, with HIV-uninfected individuals as the reference group. Hazard ratios (HRs) were obtained from Cox regression models with adjustment for age, sex, race/ethnicity, year, ACS type, smoking, and cardiovascular risk factors. RESULTS: Among 226 HIV-infected and 86 321 HIV-uninfected individuals with ACS, HIV-infected individuals had a similar risk of ACS recurrence compared with HIV-uninfected individuals [HR 1.08; 95% confidence interval (CI) 0.76-1.54]. HIV infection was independently associated with all-cause mortality after ACS hospitalization overall (HR 2.52; 95% CI 1.81-3.52). In CD4-stratified models, post-ACS mortality was higher for HIV-infected individuals with CD4 counts of 201-499 cells/μL (HR 2.64; 95% CI 1.66-4.20) and < 200 cells/μL (HR 5.41; 95% CI 3.14-9.34), but not those with CD4 counts ≥ 500 cells/μL (HR 0.67; 95% CI 0.22-2.08), compared with HIV-uninfected individuals (P trend < 0.001). CONCLUSIONS: HIV infection and immunodeficiency were not associated with recurrence of ACS after hospitalization. All-cause mortality was higher among HIV-infected compared with HIV-uninfected individuals, but there was no excess mortality risk among HIV-infected individuals with high CD4 counts.
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Marcus et al. (2018) conducted a cohort in Acute Coronary Syndrome (ACS) (n=86,547). HIV infection vs. HIV-uninfected individuals was evaluated on Recurrent acute coronary syndrome within 3 years (HR 1.08, 95% CI 0.76-1.54, p=0.42). HIV infection was not associated with an increased risk of recurrent ACS within three years compared to HIV-uninfected individuals (HR 1.08, 95% CI 0.76-1.54).
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