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Clin Infect Dis. 2016 Dec 1;63(11):1423-1430. Epub 2016 Aug 18.

Baseline, Time-Updated, and Cumulative HIV Care Metrics for Predicting Acute Myocardial Infarction and All-Cause Mortality.

Author information

1
School of Medicine.
2
Rollins School of Public Health, Emory University.
3
Atlanta Veterans Affairs Medical Center, Georgia.
4
West Haven Veterans Administration Medical Center.
5
Yale University Schools of Medicine and Public Health, New Haven, Connecticut.
6
Veterans Affairs Greater Los Angeles Health Care System and David Geffen School of Medicine at University of California-Los Angeles, California.
7
University of Pittsburgh School of Medicine and VA Pittsburgh Healthcare System, Pennsylvania.
8
Weill Cornell Medical College, Doha, Qatar and New York City.
9
Hamad Healthcare Quality Institute, Hamad Medical Corporation, Doha, Qatar.
10
Vanderbilt University, Nashville, Tennessee.
11
Wasington DC VA Medical Center and George Washington University School of Medicine, Washington D.C.
12
Infectious Diseases Section, Michael E. DeBakey VA Medical Center and Department of Medicine, Baylor College of Medicine, Houston, Texas.

Abstract

BACKGROUND:

 After adjustment for cardiovascular risk factors and despite higher mortality, those with human immunodeficiency virus (HIV+) have a greater risk of acute myocardial infarction (AMI) than uninfected individuals.

METHODS:

 We included HIV+ individuals who started combination antiretroviral therapy (cART) in the Veterans Aging Cohort Study (VACS) from 1996 to 2012. We fit multivariable proportional hazards models for baseline, time-updated and cumulative measures of HIV-1 RNA, CD4 counts, and the VACS Index. We used the trapezoidal rule to build the following cumulative measures: viremia copy-years, CD4-years, and VACS Index score-years, captured 180 days after cART initiation until AMI, death, last clinic visit, or 30 September 2012. The primary outcomes were incident AMI (Medicaid, Medicare, and Veterans Affairs International Classification of Diseases-9 codes) and death.

RESULTS:

 A total of 8168 HIV+ individuals (53 861 person-years) were analyzed with 196 incident AMIs and 1710 deaths. Controlling for known cardiovascular risk factors, 6 of the 9 metrics predicted AMI and all metrics predicted mortality. Time-updated VACS Index had the lowest Akaike information criterion among all models for both outcomes. A time-updated VACS Index score of 55+ was associated with a hazard ratio (HR) of 3.31 (95% confidence interval [CI], 2.11-5.20) for AMI and a HR of 31.77 (95% CI, 26.17-38.57) for mortality.

CONCLUSIONS:

 Time-updated VACS Index provided better AMI and mortality prediction than CD4 count and HIV-1 RNA, suggesting that current health determines risk more accurately than prior history and that risk assessment can be improved by biomarkers of organ injury.

KEYWORDS:

HIV; VACS Index; acute myocardial infarction; mortality

PMID:
27539575
PMCID:
PMC5106607
DOI:
10.1093/cid/ciw564
[Indexed for MEDLINE]
Free PMC Article

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