A huge, well-controlled study affirms that HIV infection, whether treated or not, is an independent cardiovascular risk factor.

Despite much study, the connection between HIV and coronary heart disease (CHD) remains tantalizingly difficult to confirm, in part because few studies have been able to definitively control for all the more traditional cardiovascular risk factors. Now, researchers have followed up a large prospective cohort of more than 82,000 veterans (mean age, 48; 97% men; 48% black) from 2003 through 2009 for development of myocardial infarction (MI). About one third of participants were HIV infected, and at baseline about half of these individuals were receiving antiretroviral therapy (ART).

At study entry, CHD risk by Framingham criteria was intermediate for both HIV-infected and HIV-uninfected participants (Framingham risk score=6). After about 6 years, 871 acute MIs had been diagnosed in the cohort. After adjustment for standard Framingham risk factors, comorbid disease, and substance use, MI risk was 50% higher among the HIV-infected participants than among the uninfected. This elevated risk persisted in the absence of other risk factors for MI, including hepatitis C virus infection, renal disease, and anemia. When results were parsed by age, HIV infection conferred a significant risk among participants who were 40 to 49, 50 to 59, or 60 to 69, but not among younger or older participants.

Within the HIV-infected group, baseline CD4-cell count, viral load, and ART did not influence MI risk, although recent immunologic or virologic evidence of uncontrolled infection was associated with elevated risk. Among individual components of ART, only protease inhibitor use had borderline significance as an MI risk factor.

CITATION(S):

Freiberg MS et al. HIV infection and the risk of acute myocardial infarction. JAMA Intern Med 2013 Mar 4.

Mallon PWG. Getting to the heart of HIV and myocardial infarction. JAMA Intern Med 2013 Mar 4;