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Decreasing rates of acute myocardial infarction in people living with HIV : a nationwide cohort study in Spain, 2004–2015
Author(s) -
Masiá M,
Padilla S,
García JA,
Bernardino JI,
Campins AA,
Asensi V,
Gutiérrez F
Publication year - 2018
Publication title -
hiv medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.53
H-Index - 79
eISSN - 1468-1293
pISSN - 1464-2662
DOI - 10.1111/hiv.12616
Subject(s) - medicine , myocardial infarction , confidence interval , demography , poisson regression , population , cohort , incidence (geometry) , rate ratio , human immunodeficiency virus (hiv) , cohort study , gerontology , pediatrics , family medicine , environmental health , physics , sociology , optics
Objectives Contemporary data from country‐wide cohorts are needed to reveal trends in the occurrence of acute myocardial infarction ( AMI ) in people living with HIV ( PLWH ). We analysed time trends in the standardized incidence rate ( sIR ) of AMI in PLWH in Spain from 2004 to 2015, and compared them with trends in the general population. Methods A longitudinal study in a nationwide contemporary multicentre HIV ‐infected cohort was carried out. Data on all incident AMI events were collected, and age‐ and sex‐standardized IR s calculated. To analyse the IR of AMI in the general population, the national rates of hospital discharges for AMI per 100 000 inhabitants stratified for age and sex from 2004 to 2015 were obtained using the morbidity report data from the National Statistics Institute. A Poisson regression model was fitted to assess the effect of covariates of interest on AMI occurrence. Results The sIR s of AMI in 2004–2015 were 237.92 [95% confidence interval ( CI ) 225.95–249.90] and 66.75 (95% CI: 23.49–110.01) per 100 000 patient‐years in male and female PLWH , respectively. There was a decrease in the sIR of AMI in male PLWH from 279.02 (95% CI: 265.46–292.59) per 100 000 person‐years in 2004–2009 to 222.13 (95% CI: 210.83–233.42) per 100 000 person‐years in 2010–2015. Compared with the general population, the sIR ratio was 1.41 (95% CI: 1.26–1.55) in 2004–2009, and 1.28 (95% CI : 1.15–1.43) in 2010–2014. AMI occurrence was associated with older age ( P < 0.066 for each 10‐year age stratum ≥ 35‐years compared with the 25‐34 year stratum), higher plasma HIV RNA ( P < 0.001), lower CD 4 count ( P < 0.04 for CD 4 strata > 350 cells/μL compared with the 0‐100 cells/μL stratum), and the period 2004–2009 ( P < 0.001). Conclusions There has been a decreasing incidence of AMI in PLWH in Spain, associated with improving immune and virological status, but the incidence of AMI has remained higher than in the general population.