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Recurrence after hospitalization for acute coronary syndrome among HIV-infected and HIV-uninfected individuals.
HIV Med 2019; 20(1):19-26HM

Abstract

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.

Authors+Show Affiliations

Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA.Kaiser Permanente Division of Research, Oakland, CA.Kaiser Permanente San Francisco Medical Center, San Francisco, CA.Kaiser Permanente San Francisco Medical Center, San Francisco, CA.Kaiser Permanente San Leandro Medical Center, San Leandro, CA.Kaiser Permanente Mid-Atlantic Permanente Research Institute, Rockville, MD, USA.Kaiser Permanente Division of Research, Oakland, CA.Kaiser Permanente Division of Research, Oakland, CA.Kaiser Permanente Division of Research, Oakland, CA.Kaiser Permanente Division of Research, Oakland, CA.Kaiser Permanente Division of Research, Oakland, CA.Kaiser Permanente Division of Research, Oakland, CA.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

30178911

Citation

Marcus, J L., et al. "Recurrence After Hospitalization for Acute Coronary Syndrome Among HIV-infected and HIV-uninfected Individuals." HIV Medicine, vol. 20, no. 1, 2019, pp. 19-26.
Marcus JL, Hurley LB, Prasad A, et al. Recurrence after hospitalization for acute coronary syndrome among HIV-infected and HIV-uninfected individuals. HIV Med. 2019;20(1):19-26.
Marcus, J. L., Hurley, L. B., Prasad, A., Zaroff, J., Klein, D. B., Horberg, M. A., ... Silverberg, M. J. (2019). Recurrence after hospitalization for acute coronary syndrome among HIV-infected and HIV-uninfected individuals. HIV Medicine, 20(1), pp. 19-26. doi:10.1111/hiv.12670.
Marcus JL, et al. Recurrence After Hospitalization for Acute Coronary Syndrome Among HIV-infected and HIV-uninfected Individuals. HIV Med. 2019;20(1):19-26. PubMed PMID: 30178911.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Recurrence after hospitalization for acute coronary syndrome among HIV-infected and HIV-uninfected individuals. AU - Marcus,J L, AU - Hurley,L B, AU - Prasad,A, AU - Zaroff,J, AU - Klein,D B, AU - Horberg,M A, AU - Go,A S, AU - DeLorenze,G N, AU - Quesenberry,C P,Jr AU - Sidney,S, AU - Lo,J C, AU - Silverberg,M J, Y1 - 2018/09/04/ PY - 2018/07/18/accepted PY - 2018/9/5/pubmed PY - 2018/9/5/medline PY - 2018/9/5/entrez KW - HIV KW - CD4 lymphocyte count KW - acute coronary syndrome KW - cardiovascular diseases KW - myocardial infarction SP - 19 EP - 26 JF - HIV medicine JO - HIV Med. VL - 20 IS - 1 N2 - 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. SN - 1468-1293 UR - https://www.unboundmedicine.com/medline/citation/30178911/Recurrence_after_hospitalization_for_acute_coronary_syndrome_among_HIV_infected_and_HIV_uninfected_individuals_ L2 - https://doi.org/10.1111/hiv.12670 DB - PRIME DP - Unbound Medicine ER -