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AIDS. 2013 Nov 13;27(17):2735-48. doi: 10.1097/01.aids.0000432457.91228.f3.

Associations between immune depression and cardiovascular events in HIV infection.

Collaborators (709)

Shortman N, Butcher D, Rode R, Franquet X, Powderly W, Ryom L, Sabin CA, Kamara D, Smith C, Phillips A, Mocroft A, Tverland J, Nielsen J, Lundgren JD, Brandt R, Rickenbach M, Fanti I, Krum E, Hillebregt M, Geffard S, Sundström A, Delforge M, Fontas E, Torres F, McManus H, Wright S, Kjær J, Sjøl A, Meidahl P, Helweg-Larsen J, Iversen J, de Wolf F, Zaheri S, Gras MH, Prins JM, Kuijpers TW, Scherpbier HJ, Boer K, van der Meer JT, Wit FW, Godfried MH, Reiss P, van der Poll T, Nellen FJ, Lange JM, Geerlings SE, van Vugt M, Vrouenraets SM, Pajkrt D, van der Valk M, Schreij G, Lowe S, Lashof AO, Pronk MJ, Bravenboer B, van der Ende ME, de Vries- Sluijs TE, Schurink CA, van der Feltz M, Nouwen JL, Gelinck LB, Verbon A, Rijnders BJ, Slobbe L, Hartwig NG, Driessen GJ, Branger J, Haag D, Kauffmann RH, Schippers EF, Groeneveld PH, Alleman MA, Bouwhuis JW, Gasthuis K, ten Kate RW, Soetekouw R, Kroon FP, van den Broek PJ, van Dissel JT, Arend SM, van Nieuwkoop C, de Boer MG, Jolink H, Hollander JG, Pogany K, van Twillert G, Kortmann W, Haaglanden C, Haag D, Vriesendorp R, Leyten EM, ten Napel CH, Kootstra GJ, Brinkman K, Blok WL, Frissen PH, Schouten WE, van den Berk GE, Juttmann JR, Brouwer AE, Ziekenhuis LA, Veenstra J, Lettinga KD, Mulder JW, van Gorp EC, Smit PM, Weijer S, van Eeden A, Verhagen DW, Sprenger HG, Doedens R, Scholvinck EH, Sprenger HG, Doedens R, Scholvinck EH, van Assen S, Stek CJ, Koopmans PP, de Groot R, Keuter M, van der Ven AJ, ter Hofstede HJ, van der Flier M, Brouwer AM, Dofferhoff AS, Hoepelman AI, Mudrikova T, Schneider MM, Jaspers CA, Ellerbroek PM, Peters EJ, Maarschalk-Ellerbroek LJ, Oosterheert JJ, Arends JE, Wassenberg MW, van der Hilst JC, Danner SA, van Agtmael MA, de Vocht J, Perenboom RM, Claessen FA, Bierman WF, de Jong EV, bij de Vaate EA, Geelen SP, Wolfs TF, Richter C, van der Berg JP, Gisolf EH, van den Berge M, Stegeman A, van Houte DP, Polée MB, van Vonderen MG, Winkel C, Duits AJ, Dabis F, Bonnet F, Dabis F, Dupon M, Chêne G, Fleury H, Lacoste D, Malvy D, Mercié P, Pellegrin I, Morlat P, Neau D, Pellegrin JL, Thiébaut R, Titier K, Bruyand M, Chêne G, Dabis F, Lawson-Ayayi S, Thiébaut R, Wittkop L, Bonnal F, Bonnet F, Bernard N, Caunègre L, Cazanave C, Ceccaldi J, Chambon D, Chossat I, Courtaud K, Dauchy FA, De Witte S, Dupon M, Dupont A, Duffau P, Dutronc H, Farbos S, Gaboriau V, Gemain MC, Gerard Y, Greib C, Hessamfar M, Lacoste D, Lataste P, Lafarie-Castet S, Lazaro E, Longy-Boursier M, Malvy D, Meraud JP, Mercié P, Monlun E, Morlat P, Neau D, Ochoa A, Pellegrin JL, Pistone T, Ragnaud JM, Receveur MC, Roger-Schmeltz J, Tchamgoué S, Thibaut P, Vandenhende MA, Viallard JF, Moreau JF, Pellegrin I, Fleury H, Lafon ME, Masquelier B, Trimoulet P, Breilh D, Titier K, Haramburu F, Miremont-Salame G, Blaizeau MJ, Decoin M, Delaune J, Delveaux S, D' Ivernois C, Hanappier C, Leleux O, Uwamaliya-Nziyumvira B, Sicard X, Geffard S, Leray J, Palmer G, Touchard D, Law M, Petoumenos K, McManus H, Wright S, Bendall C, Moore R, Edwards S, Hoy J, Watson K, Roth N, Nicholson J, Bloch M, Franic T, Baker D, Vale R, Carr A, Cooper D, Chuah J, Ngieng M, Nolan D, Skett J, Calvo G, Torres F, Mateu S, Domingo P, Sambeat MA, Gatell J, Del Cacho E, Cadafalch J, Fuster M, Codina C, Sirera G, Vaque A, De Wit S, Clumeck N, Delforge M, Necsoi C, Clumeck N, De Wit S, Gennotte AF, Gerard M, Kabeya K, Konopnicki D, Libois A, Martin C, Payen MC, Semaille P, Van Y, Neaton J, Bartsch G, El-Sadr WM, Krum E, Thompson G, Wentworth D, Luskin-Hawk R, Telzak E, El-Sadr WM, Abrams DI, Cohn D, Markowitz N, Arduino R, Mushatt D, Friedland G, Perez G, Tedaldi E, Fisher E, Gordin F, Crane LR, Sampson J, Baxter J, Lundgren J, Kirk O, Mocroft A, Cozzi-Lepri A, Grint D, Podlekareva D, Kjær J, Peters L, Reekie J, Kowalska J, Tverland J, Fischer AH, Losso M, Elias C, Vetter N, Zangerle R, Karpov I, Vassilenko A, Mitsura VM, Suetnov O, Clumeck N, DeWit S, Delforge M, Colebunders R, Vandekerckhove L, Hadziosmanovic V, Kostov K, Begovac J, Machala L, Jilich D, Sedlacek D, Nielsen J, Kronborg G, Benfield T, Larsen M, Gerstoft J, Katzenstein T, Hansen AB, Skinhøj P, Pedersen C, Ostergaard L, Zilmer K, Smidt J, Ristola M, Katlama C, Viard JP, Girard PM, Livrozet JM, Vanhems P, Pradier C, Dabis F, Neau D, Rockstroh J, Schmidt R, van Lunzen J, Degen O, Stellbrink HJ, Staszewski S, Bogner J, Fätkenheuer G, Kosmidis J, Gargalianos P, Xylomenos G, Perdios J, Panos G, Filandras A, Karabatsaki E, Sambatakou H, Banhegyi D, Mulcahy F, Yust I, Turner D, Burke M, Pollack S, Hassoun G, Maayan S, Vella S, Esposito R, Mazeu I, Mussini C, Arici C, Pristera R, Mazzotta F, Gabbuti A, Vullo V, Lichtner M, Chirianni A, Montesarchio E, Gargiulo M, Antonucci G, Testa A, Narciso P, Vlassi C, Zaccarelli M, Lazzarin A, Castagna A, Gianotti N, Galli M, Ridolfo A, d'Arminio Monforte A, Rozentale B, Zeltina I, Chaplinskas S, Hemmer R, Staub T, Reiss P, Ormaasen V, Maeland A, Bruun J, Knysz B, Gasiorowski J, Horban A, Bakowska E, Grzeszczuk A, Flisiak R, Boron-Kaczmarska A, Pynka M, Parczewski M, Beniowski M, Mularska E, Trocha H, Jablonowska E, Malolepsza E, Wojcik K, Antunes F, Doroana M, Caldeira L, Mansinho K, Maltez F, Duiculescu D, Rakhmanova A, Zakharova N, Buzunova S, Jevtovic D, Mokrás M, Staneková D, Tomazic J, González-Lahoz J, Soriano V, Labarga P, Medrano J, Moreno S, Rodriguez JM, Clotet B, Jou A, Paredes R, Tural C, Puig J, Bravo I, Gatell JM, Miró JM, Domingo P, Gutierrez M, Mateo G, Sambeat MA, Karlsson A, Flamholc L, Ledergerber B, Weber R, Francioli P, Cavassini M, Hirschel B, Boffi E, Furrer H, Battegay M, Elzi L, Kravchenko E, Chentsova N, Frolov V, Kutsyna G, Servitskiy S, Krasnov M, Barton S, Johnson AM, Mercey D, Phillips A, Johnson MA, Mocroft A, Murphy M, Weber J, Scullard G, Fisher M, Leen C, Morfeldt L, Thulin G, Sundström A, Åkerlund B, Koppel K, Karlsson L, Flamholc A, Håkangård C, Moroni M, Angarano G, Antinori A, Castelli F, Cauda R, Di Perri G, Galli M, Iardino R, Ippolito G, Lazzarin A, Perno CF, Armignacco O, Viale PL, Von Schlosser F, Ammassari A, Andreoni M, Antinori A, Balotta C, Bonfanti P, Bonora S, Borderi M, Capobianchi MR, Castagna A, Ceccherini-Silberstein F, Cinque P, Cozzi-Lepri A, De Luca A, Gargiulo M, Gervasoni C, Girardi E, Gori A, Guaraldi G, Lichtner M, Caputo S, Madeddu G, Maggiolo F, Marchetti G, Marcotullio S, Monno L, Murri R, Mussini C, Puoti M, Torti C, Cozzi-Lepri A, Cicconi P, Fanti I, Formenti T, Galli L, Lorenzini P, Giacometti A, Costantini A, Riva A, Angarano G, Monno L, Carrisa C, Maggiolo F, Lazzari G, Viale PL, Borderi M, Verucchi G, Castelli F, Torti C, Minardi C, Quirino T, Abeli C, Manconi PE, Piano P, Vecchiet J, Falasca K, Sighinolfi L, Segala D, Mazzotta F, Caputo L, Cassola G, Viscoli G, Alessandrini A, Piscopo R, Mazzarello G, Mastroianni C, Belvisi V, Bonfanti P, Caramma I, Chiodera A, Castelli P, Galli M, Lazzarin A, Rizzardini G, Puoti M, Ridolfo AL, Piolini R, Castagna A, Salpietro S, Galli A, Bigoloni A, Spagnuolo V, Carenzi L, Zucchi P, Moioli MC, Rossotti R, Cicconi P, Formenti T, Mussini C, Bisio L, Gori A, Lapadula G, Abrescia N, Chirianni A, Guida MG, Gargiulo M, Baldelli F, Belfiori B, Parruti G, Ursini T, Magnani G, Cauda MA, Andreoni M, Antinori A, Tozzi V, Vullo V, De Luca A, d' Avino A, Zaccarelli M, Gallo L, Nicastro E, Acinapura R, Capozzi M, Libertone R, Lichtner M, Tebano G, Mura MS, Madeddu G, Caramello P, Di G, Orofino GC, Sciandra M, Pellizzer G, Manfrin V, Pradier C, Fontas E, Caissotti C, Dellamonica P, Bernard E, Cua E, De Salvador-Guillouet F, Durant J, Ferrando S, Mondain-Miton V, Naqvi A, Perbost I, Prouvost-Keller B, Pillet S, Pugliese P, Rahelinirina V, Roger PM, Dollet K, Barth J, Battegay M, Bernasconi E, Bo J, Bucher HC, Burton-Jeangros C, Calmy A, Cavassini M, Cellerai C, Dubs R, Egger M, Elzi L, Fehr J, Flepp M, Francioli P, Furrer H, Fux CA, Gorgievski M, Gu H, Hasse B, Hirsch HH, Hirschel B, Ho I, Kahlert C, Kaiser L, Keiser O, Kind C, Klimkait T, Kovari H, Ledergerber B, Martinetti G, de Tejada B, Mu N, Nadal D, Pantaleo G, Rauch A, Regenass S, Rickenbach M, Rudin C, Schmid P, Schultze D, Schöni-Affolter F, Schüpbach J, Speck R, Taffe P, Telenti A, Trkola A, Vernazza P, von Wyl V, Weber R, Yerly S.

Abstract

OBJECTIVE:

To consider associations between the latest/nadir CD4 cell count, and time spent with CD4 cell count less than 200 cells/μl (duration of immune depression), and myocardial infarction (MI), coronary heart disease (CHD), stroke, or cardiovascular disease (CVD) (CHD or stroke) in 33 301 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 <100 cells/μl: relative rate (95% confidence interval) 0.96 (0.62-1.50) for MI, 0.89 (0.30-2.36) for CHD; nadir CD4 <100 cells/μl: 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 100 cells/μl [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.

[Indexed for MEDLINE]
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