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Recurrence after hospitalization for acute coronary syndrome among HIV ‐infected and HIV ‐uninfected individuals
Author(s) -
Marcus JL,
Hurley LB,
Prasad A,
Zaroff J,
Klein DB,
Horberg MA,
Go AS,
DeLorenze GN,
Quesenberry CP,
Sidney S,
Lo JC,
Silverberg MJ
Publication year - 2019
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.12670
Subject(s) - medicine , hazard ratio , acute coronary syndrome , unstable angina , confidence interval , myocardial infarction , proportional hazards model , cohort , human immunodeficiency virus (hiv) , retrospective cohort study , immunology
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 CD 4 count, with HIV ‐uninfected individuals as the reference group. Hazard ratios ( HR s) 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 CD 4‐stratified models, post‐ ACS mortality was higher for HIV ‐infected individuals with CD 4 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 CD 4 counts.