A latest CD4 count <100 cells/μl in HIV patients was not associated with higher MI risk (RR 0.96; 95% CI 0.62-1.50) but was associated with higher stroke risk (RR 2.26; 95% CI 1.29-3.94).
Cohort (n=33,301)
Does immune depression increase the risk of cardiovascular events in HIV-positive individuals?
In HIV-positive individuals, severe immune depression (CD4 <100 cells/μl) is associated with an increased risk of stroke but not myocardial infarction or coronary heart disease.
Effect estimate: RR 0.96 (95% CI 0.62-1.50)
OBJECTIVE: To consider associations between the latest/nadir CD4 cell count, and time spent with CD4 cell count less than 200 cells/μl (duration of immune depression), and myocardial infarction (MI), coronary heart disease (CHD), stroke, or cardiovascular disease (CVD) (CHD or stroke) in 33 301 HIV-positive individuals. DESIGN: Longitudinal cohort study. METHODS: Analyses were undertaken using Poisson regression. To investigate whether analyses of stroke were robust to the type of endpoint, we additionally included stroke-like events and rejected strokes into the stroke endpoint. RESULTS: Participants experienced 716 MI, 1056 CHD, 303 stroke, and 1284 CVD events. Whereas there was no evidence of a higher MI/CHD risk in those with lower latest/nadir CD4 cell counts after adjustment current CD4 <100 cells/μl: relative rate (95% confidence interval) 0.96 (0.62-1.50) for MI, 0.89 (0.30-2.36) for CHD; nadir CD4 <100 cells/μl: 1.36 (0.57-3.23) for MI, 0.98 (0.45-2.16) for CHD, stroke and CVD rates were higher in those with a latest CD4 cell count less than 100 cells/μl 2.26 (1.29-3.94) and 1.14 (0.84-1.56), respectively. All events occurred less frequently in those who had not experienced immune depression, although evidence for a linear association with duration of immune depression was weak. The association between stroke risk and the latest CD4 cell count strengthened as stroke-like and rejected strokes were included; conversely, associations with established stroke risk factors weakened. CONCLUSION: We do not find strong evidence that HIV-positive individuals with a low CD4 cell count are more likely to experience MI/CHD. Although strokes appear to occur more commonly at low CD4 cell counts, this may be partly explained by misclassification or other biases.
Sabin et al. (Wed,) conducted a cohort in HIV infection (n=33,301). Latest/nadir CD4 cell count <100 cells/μl vs. Higher CD4 cell counts was evaluated on Myocardial infarction (MI) (RR 0.96, 95% CI 0.62-1.50). A latest CD4 count <100 cells/μl in HIV patients was not associated with higher MI risk (RR 0.96; 95% CI 0.62-1.50) but was associated with higher stroke risk (RR 2.26; 95% CI 1.29-3.94).