Klein D, Hurley L; Conference on Retroviruses and Opportunistic Infections.
9th Conf Retrovir Oppor Infect Feb 24 28 2002 Wash State Conv Trade Cent Seattle Wash Conf Retrovir Oppor Infect 9th 2002 Seattle Wash. 2002 Feb 24-28; 9: abstract no. 696-T.
Kaiser Permanente Med. Care Program, Oakland, CA
BACKGROUND: Concern persists that antiretroviral therapy (ART), particularly protease inhibitors (PI) may increase risk for coronary heart disease (CHD) among HIV+ patients. We previously reported no difference in CHD hospitalization rates among HIV+ patients regardless of PI exposure. Now with up to 5.5 years of follow-up, we report up-dated hospitalization rates for CHD and myocardial infarction (MI). We also report prevalence of classic CHD risk factors.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 years and members of the Kaiser Permanente Northern California HMO. Follow-up began January 1, 1996 and ended at the earliest of member termination or June 30, 2001. For cases, follow-up in person-years was assigned by treatment exposure category separately as any ART vs no ART, and as any PI vs no PI. In each comparison, cases could contribute person-years 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: 4159 cases contributed 14,823 person-years of follow-up (median 4.1); 40,000 controls contributed 190,000 person-years of follow-up. There were 72 CHD events (47 Mis) among cases. Age-adjusted CHD rates, pre- vs post- any ART (5.7 vs 6.8 events/1000 person-years) and pre- vs post-PI (6.2 vs 6.7), were similar, as were MI rates pre- vs post-PI (4.4 vs 4.3). In cases vs controls, CHD rates were higher (6.5 vs 3.8 events / 1000 person-years, p=0.003) and the difference in MI rates approached significance (4.3 vs 2.9, p=0.07). Differences in proportions with classic CHD risk factors were mixed (cases vs controls): hyperlipidemia 21% vs 16%, smoking 19% vs 10%, hypertension 18% vs 25%, and diabetes 7% vs 9%.CONCLUSIONS: After 5.5 years we find no effect of treatment type on CHD or MI hospitalization rates among HMO-enrolled HIV+ men. However, the rates are higher among HIV+ vs HIV- men. This may be due to chronic infection or to other co-factors not studied here. Longer follow-up is needed and risk reduction management is warranted in all patients with multiple CHD risks.
Publication Types:
Keywords:
- Acquired Immunodeficiency Syndrome
- Antiretroviral Therapy, Highly Active
- California
- Coronary Disease
- Diabetes Mellitus
- HIV Infections
- HIV Seropositivity
- Hospitalization
- Humans
- Hypertension
- Male
- Myocardial Infarction
- Prevalence
- Risk Factors
- Smoking
- United States
Other ID:
UI: 102263693
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