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Ischemic cardiovascular disease in persons with human immunodeficiency virus infection
Max H David1, Richard Hornung, Carl J Fichtenbaum
1Department of Medicine, Division of Infectious Diseases, University of Cincinnati College of Medicine, Cincinnati, OH 45267-0405 , USA.
Insights
People with human immunodeficiency virus (HIV) may face increased risk for ischemic cardiovascular disease (CVD). Traditional risk factors, lower CD4 counts, and longer nucleoside analog exposure are associated with CVD in HIV patients.
Area of Science:
- Cardiology
- Infectious Diseases
- Immunology
Background:
- Human immunodeficiency virus (HIV) infection is a growing concern for cardiovascular health.
- Ischemic cardiovascular disease (CVD) may disproportionately affect HIV-infected individuals.
Purpose of the Study:
- To investigate the occurrence and risk factors of ischemic CVD in HIV-infected patients.
- To compare CVD risk factors between HIV-infected patients with CVD and matched controls.
Main Methods:
- Retrospective review of 16 HIV-infected patients with diagnosed ischemic CVD (angina or myocardial infarction).
- Comparison with 32 age- and sex-matched HIV-infected controls without CVD.
- Analysis of traditional CVD risk factors, CD4+ lymphocyte counts, and antiretroviral therapy exposure.
Main Results:
- Ischemic CVD was identified in 1.7% of HIV-infected persons at the institution during the study period.
- HIV patients with CVD had significantly more traditional CVD risk factors (median 3 vs. 1).
- Lower nadir CD4+ lymphocyte counts (median 101 vs. 278 cells/mm3) and longer nucleoside analog exposure (median 190 vs. 130 weeks) were associated with CVD.
Conclusions:
- Ischemic CVD is a clinical reality in HIV-infected individuals.
- Traditional coronary artery disease risk factors are strongly associated with ischemic CVD in this population.
- Lower CD4+ counts and longer HIV duration may serve as risk factors or markers for ischemic CVD development.
Abstract:
Persons with human immunodeficiency virus (HIV) infection might be at risk for ischemic cardiovascular disease (CVD). We reviewed the records of 16 HIV-infected persons with proven CVD (8 cases of angina and 8 cases of myocardial infarctions). This represents 1.7% of HIV-infected persons seen at our institution from 1 April 1999 through 25 April 2000. In comparison with 32 HIV-infected age- and sex-matched controls, case patients had more risk factors for CVD (median number of risk factors for CVD, 3 versus 1; P<.001), lower nadir CD4+ lymphocyte counts (median, 101 cells/mm3 versus 278 cells/mm3; P=.02), and a longer duration of prior exposure to nucleoside analogs (median, 190 weeks versus 130 weeks; P=.02). There was no difference in the duration of exposure to protease inhibitors. Ischemic CVD occurs in HIV-infected persons and appears to be most closely associated with traditional risk factors for coronary artery disease (for example, hypertension and hypercholesterolemia). Lower CD4+ lymphocyte counts and duration of HIV infection might also be risk factors or markers for the development of ischemic CVD.