Increased mortality after a first myocardial infarction in human immunodeficiency virus-infected patients; a nested cohort study.

Carballo, David; Delhumeau, Cécile; Carballo, Sebastian; Bähler, Caroline; Radovanovic, Dragona; Hirschel, Bernard; Clerc, Olivier; Bernasconi, Enos; Fasel, Dominique; Schmid, Patrick; Cusini, Alexia; Fehr, Jan; Erne, Paul; Keller, Pierre-Fréderic; Ledergerber, Bruno; Calmy, Alexandra (2015). Increased mortality after a first myocardial infarction in human immunodeficiency virus-infected patients; a nested cohort study. AIDS research and therapy, 12(4), p. 4. BioMed Central 10.1186/s12981-015-0045-z

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AIMS

HIV infection may be associated with an increased recurrence rate of myocardial infarction. Our aim was to determine whether HIV infection is a risk factor for worse outcomes in patients with coronaray artery disease.

METHODS

We compared data aggregated from two ongoing cohorts: (i) the Acute Myocardial Infarction in Switzerland (AMIS) registry, which includes patients with acute myocardial infarction (AMI), and (ii) the Swiss HIV Cohort Study (SHCS), a prospective registry of HIV-positive (HIV+) patients. We included all patients who survived an incident AMI occurring on or after 1st January 2005. Our primary outcome measure was all-cause mortality at one year; secondary outcomes included AMI recurrence and cardiovascular-related hospitalisations. Comparisons used Cox and logistic regression analyses, respectively.

RESULTS

There were 133 HIV+, (SHCS) and 5,328 HIV-negative [HIV-] (AMIS) individuals with incident AMI. In the SHCS and AMIS registries, patients were predominantly male (72% and 85% male, respectively), with a median age of 51 years (interquartile range [IQR] 46-57) and 64 years (IQR 55-74), respectively. Nearly all (90%) of HIV+ individuals were on successful antiretroviral therapy. During the first year of follow-up, 5 (3.6%) HIV+ and 135 (2.5%) HIV- individuals died. At one year, HIV+ status after adjustment for age, sex, calendar year of AMI, smoking status, hypertension and diabetes was associated with a higher risk of death (HR 4.42, 95% CI 1.73-11.27). There were no significant differences in recurrent AMIs (4 [3.0%] HIV+ and 146 [3.0%] HIV- individuals, OR 1.16, 95% CI 0.41-3.27) or in hospitalization rates (OR 0.68 [95% CI 0.42-1.11]).

CONCLUSIONS

HIV infection was associated with a significantly increased risk of all-cause mortality one year after incident AMI.

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