Klein D, Hurley L; Conference on Retroviruses and Opportunistic Infections.
Abstr 10th Conf Retrovir Oppor Infect Feb 10 14 2003 Hynes Conv Cent Boston Mass USA Conf Retrovir Oppor Infect 10th 2003 Boston Mass. 2003 Feb 10-14; 10: abstract no. 747.
Kaiser Permanente Med Care Prgm, Oakland, CA
BACKGROUND: Protease Inhibitors have been in widespread use for over 6 yrs. There are conflicting reports on PI use and risk for CHD. We have extended our own observation of CHD hospitalizations among a large group of HIV+ patients (pts) and report updated hospitalization rates for CHD and myocardial infarctions (MI). We also have preliminary data on CHD and MI rates in the pre-HAART era.METHODS: Hospital events for CHD (ICD9 410-414, primary discharge diagnosis) including MI were identified among HIV+ males (cases) and among a sample of males not known to be HIV+ (controls). All persons studied were aged 35-64 yrs and members of the Kaiser Permanente Northern California HMO. Follow-up (FU) began 1/1/96 and ended at the earliest of member termination or 6/30/02. For cases, person-years (PY) of FU was assigned as either pre/no-PI exposure vs PI-exposure. Cases could contribute PY to both categories. Cases and controls with prior CHD events were excluded. Age-adjusted (1990 U.S. census) CHD and MI event rates were calculated. Risk factors were obtained from electronic medical records.RESULTS: A total 4,391 HIV+ cases contributed 17,716 PY of FU in the 6.5-yr observation period (median 4.4) -approximately 3,000 PY more than what we have previously reported. Among cases there were 91 CHD events (61 MIs), and age-adjusted CHD rates in pre- vs post-PI exposure periods were similar (6.1 vs 7.1 events/1000 PY, p = 0.56); as were MI rates (4.4 vs 4.7, p = 0.60). Over 40,000 HIV-controls contributed 193,000 PY of FU. CHD rates were higher In cases vs controls (6.7 vs 4.1 events/1000 PY, p = 0.003) yet there was no apparent difference in MI rates (4.5 vs 3.7, p = 0.22). Differences in between HIV+ and HIV- pts with respect to classic CHD risks continue to be mixed. Hospitalization data from the period 1991-1995 suggest that the relatively high CHD rate among HIV+ pts compared to controls appears to be unique to the period 1996-2002.CONCLUSIONS: After an additional year of follow-up (now up to 6.5 yrs), we continue to find no effect of PI use on CHD or MI hospitalization rates among HMO-enrolled HIV+ men. However, CHD rates continue to be higher among HIV+ vs HIV- men in the HAART era. This may be due to chronic infection or to other co-factors not studied here. Longer follow-up is needed and further study of CHD and MI event rates in the pre-HAART era may be helpful. Risk reduction management is warranted in all pnts with CHD risks.
Publication Types:
Keywords:
- Acquired Immunodeficiency Syndrome
- Antiretroviral Therapy, Highly Active
- California
- Coronary Disease
- HIV Infections
- HIV Seropositivity
- Hospitalization
- Humans
- Male
- Myocardial Infarction
- Risk Factors
- United States
Other ID:
UI: 102261388
From Meeting Abstracts