Link Between Low CD4-Cell Count and Increased Risk for Coronary Artery Disease Questioned

Keith Henry, MD

Data from the DAD Study showed no increased risk for myocardial infarction or coronary artery disease with low CD4-cell counts, and only a modestly increased risk for stroke.

Although it is has become dogma that HIV-associated immune suppression is linked to increased risk for cardiovascular disease, the data supporting that view have been mixed. In a recent analysis from the DAD Study, researchers evaluated associations between latest/nadir CD4-cell counts — as well as time spent with CD4 count <200 cells/mm3 — and incident cardiovascular disease (i.e., myocardial infarction [MI], coronary artery disease [CAD], stroke, or a combination [cardiovascular disease; CVD]). By February 1, 2011, the 49,000 HIV-infected patients in the DAD cohort had experienced 716 MIs, 1056 CAD events, 303 strokes, and 1284 CVD events.

After adjustment for potential cofounders (sex, age, previous CVD, body-mass index, smoking status, and hypertension, for all analyses; in addition, clinical cohort, mode of HIV acquisition, ethnicity, family history of CVD, calendar year, and exposure to each antiretroviral drug, for the non-stroke analyses), there was no evidence of increased risk for MI/CAD events from lower recent or nadir CD4-cell counts. Stroke and cumulative CVD risk were higher in those with a latest CD4 count <100 cells/mm3 (relative risks, 2.3 and 1.14, respectively). Although all events occurred less often in patients never experiencing immune depression, the link between events and duration of immune suppression was weak. If stroke-like events and “rejected” strokes (i.e., those not meeting preestablished criteria) were included, the link between stroke risk and latest CD4-cell count was stronger, whereas associations between stroke-related events and established stroke risk factors were diminished (raising concern that misclassification of stroke-like events from AIDS-related central nervous system complications might have partially explained the observations).

Citation(s):

Sabin CA et al. Associations between immune depression and cardiovascular events in HIV infection. AIDS 2013 Nov 13; 27:2735