Associations between immune depression and cardiovascular events in HIV infection
- 13 November 2013
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in AIDS
- Vol. 27 (17), 2735-2748
- https://doi.org/10.1097/01.aids.0000432457.91228.f3
Abstract
Objective:To consider associations between the latest/nadir CD4(+) cell count, and time spent with CD4(+) cell count less than 200cells/l (duration of immune depression), and myocardial infarction (MI), coronary heart disease (CHD), stroke, or cardiovascular disease (CVD) (CHD or stroke) in 33301 HIV-positive individuals.Design:Longitudinal cohort study.Methods:Analyses were undertaken using Poisson regression. To investigate whether analyses of stroke were robust to the type of endpoint, we additionally included stroke-like events and rejected strokes into the stroke endpoint.Results:Participants experienced 716 MI, 1056 CHD, 303 stroke, and 1284 CVD events. Whereas there was no evidence of a higher MI/CHD risk in those with lower latest/nadir CD4(+) cell counts after adjustment [current CD4(+)<100cells/l: relative rate (95% confidence interval) 0.96 (0.62-1.50) for MI, 0.89 (0.30-2.36) for CHD; nadir CD4(+)<100cells/l: 1.36 (0.57-3.23) for MI, 0.98 (0.45-2.16) for CHD], stroke and CVD rates were higher in those with a latest CD4(+) cell count less than 100cells/l [2.26 (1.29-3.94) and 1.14 (0.84-1.56), respectively]. All events occurred less frequently in those who had not experienced immune depression, although evidence for a linear association with duration of immune depression was weak. The association between stroke risk and the latest CD4(+) cell count strengthened as stroke-like and rejected strokes were included; conversely, associations with established stroke risk factors weakened.Conclusion:We do not find strong evidence that HIV-positive individuals with a low CD4(+) cell count are more likely to experience MI/CHD. Although strokes appear to occur more commonly at low CD4(+) cell counts, this may be partly explained by misclassification or other biases.This publication has 33 references indexed in Scilit:
- HIV Infection and Coronary Heart Disease: An Intersection of EpidemicsThe Journal of Infectious Diseases, 2012
- Association of Immunologic and Virologic Factors With Myocardial Infarction Rates in a US Healthcare SystemJAIDS Journal of Acquired Immune Deficiency Syndromes, 2010
- Initiation of antiretroviral therapy at higher nadir CD4+ T-cell counts is associated with reduced arterial stiffness in HIV-infected individualsAIDS, 2010
- Traditional risk factors and D-dimer predict incident cardiovascular disease events in chronic HIV infectionAIDS, 2010
- Markers of Inflammation, Coagulation, and Renal Function Are Elevated in Adults with HIV InfectionThe Journal of Infectious Diseases, 2010
- High‐Density Lipoprotein Particles and Markers of Inflammation and Thrombotic Activity in Patients with Untreated HIV InfectionThe Journal of Infectious Diseases, 2010
- Association of C-Reactive Protein and HIV Infection With Acute Myocardial InfarctionJAIDS Journal of Acquired Immune Deficiency Syndromes, 2009
- HIV infection and the risk of diabetes mellitusAIDS, 2009
- The role of HIV in serious diseases other than AIDSAIDS, 2008
- Low CD4+ T-cell count as a major atherosclerosis risk factor in HIV-infected women and menAIDS, 2008