Increased Risk of Myocardial Infarction in HIV-Infected Individuals in North America Compared With the General Population.
Increased Risk of Myocardial Infarction in HIV-Infected Individuals in North America Compared With the General Population.
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DOI：
10.1097/qai.0000000000001450
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发表时间：
2017-08-15
期刊：
影响因子：
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通讯作者：
Crane HM
中科院分区：
文献类型：
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作者：
Drozd DR;Kitahata MM;Althoff KN;Zhang J;Gange SJ;Napravnik S;Burkholder GA;Mathews WC;Silverberg MJ;Sterling TR;Heckbert SR;Budoff MJ;Van Rompaey S;Delaney JAC;Wong C;Tong W;Palella FJ;Elion RA;Martin JN;Brooks JT;Jacobson LP;Eron JJ;Justice AC;Freiberg MS;Klein DB;Post WS;Saag MS;Moore RD;Crane HM
由于无法验证和区分动脉粥样硬化性1型心肌梗死（T1MIs）与其他事件，先前对hiv感染者心血管疾病（CVD）的研究受到限制。我们试图在北美艾滋病队列合作研究与设计（NA-ACCORD）的参与者中定义T1MIs的发病率和归因于传统因素和hiv特异性因素的风险，并将调整后的发病率与社区普通人群动脉粥样硬化风险（ARIC）队列进行比较。我们在1995-2014年7个NA-ACCORD队列中确定并判定了事件MIs。我们使用泊松回归计算T1MI危险因素的发病率（IR）、调整发病率比（aIRRs）和95%置信区间（[,]）。我们比较了NA-ACCORD组T1MIs与ARIC组的airr。在29169名hiv感染者中，t1mi的IR为2.57[2.30-2.86]/ 1000人-年，与ARIC参与者相比，其IR显著升高（1.30[1.09-1.56]）。在限于hiv感染者并包括传统心血管疾病危险因素的多变量分析中，T1MI率随着CD4计数的降低而增加（≥500个细胞/μL: ref； 350-499个细胞/μL: aIRR=1.32[0.98-1.77]； 200-349个细胞/μL: aIRR=1.37[1.01-1.86]； 100 - 199个细胞/μL: aIRR=1.60[1.09-2.34]; <100个细胞/μL: aIRR=2.19[1.44-3.33]）。仅当排除CD4时，与可检测到的HIV RNA（<400拷贝/mL: ref；≥400拷贝/mL: aIRR=1.36[1.06-1.75]）相关的风险才显著增加。HIV感染者T1MI发生率较高，且与CD4计数和可检测到的HIV RNA较低相关的风险增加，这表明早期抑制性抗逆转录病毒治疗和对传统心血管疾病危险因素的积极管理是最大限度地降低MI风险的必要条件。
Previous studies of cardiovascular disease (CVD) among HIV-infected individuals have been limited by the inability to validate and differentiate atherosclerotic type 1 myocardial infarctions (T1MIs) from other events. We sought to define the incidence of T1MIs and risk attributable to traditional and HIV-specific factors among participants in the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD), and compare adjusted incidence rates to the general population Atherosclerosis Risk in Communities (ARIC) cohort. We ascertained and adjudicated incident MIs among individuals enrolled in seven NA-ACCORD cohorts between 1995–2014. We calculated incidence rates (IR), adjusted incidence rate ratios (aIRRs), and 95% confidence intervals ([,]) of risk factors for T1MI using Poisson regression. We compared aIRRs of T1MIs in NA-ACCORD with those from ARIC. Among 29,169 HIV-infected individuals, the IR for T1MIs was 2.57[2.30–2.86] per 1000 person-years, and the aIRR was significantly higher compared with participants in ARIC (1.30[1.09–1.56]). In multivariable analysis restricted to HIV-infected individuals and including traditional CVD risk factors, the rate of T1MI increased with decreasing CD4 count (≥500 cells/μL: ref; 350–499 cells/μL: aIRR=1.32[0.98–1.77]; 200–349 cells/μL: aIRR=1.37[1.01–1.86]; 100–199 cells/μL: aIRR=1.60[1.09–2.34]; <100 cells/μL: aIRR=2.19[1.44–3.33]). Risk associated with detectable HIV RNA (<400 copies/mL: ref; ≥400 copies/mL: aIRR=1.36 [1.06–1.75]) was significantly increased only when CD4 was excluded. The higher incidence of T1MI in HIV-infected individuals and increased risk associated with lower CD4 count and detectable HIV RNA suggest that early suppressive antiretroviral treatment and aggressive management of traditional CVD risk factors are necessary to maximally reduce MI risk.