CONFERENCE ON RETROVIRUSES
AND OPPORTUNISTIC INFECTIONS

March 8–11, 2020

 

Conference Dates and Location: 
February 23-26, 2015 | Seattle, Washington
Abstract Number: 
746

Cumulative HIV Care Measures Highly Associated With Acute Myocardial Infarction

Author(s): 

Jorge L. Salinas1, Christopher T. Rentsch2, Vincent C. Marconi1, Janet Tate3, Adeel A. Butt4, Matthew S. Freiberg4, Matthew B. Goetz5, Maria Rodriguez-Barradas6, Amy Justice3, David Rimland1
1 Infectious Diseases, Emory University, Atlanta, GA, United States. 2 Infectious Diseases, Atlanta VA Hospital, Decatur, GA, United States. 3 Internal Medicine, Yale University, New Haven, CT, United States. 4 Infectious Diseases, University of Pittsburgh, Pittsburgh, PA, United States. 5 Infectious Diseases, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, United States. 6 Infectious Diseases, Baylor College of Medicine, Houston, TX, United States.

Abstract Body: 

Background: After accounting for established risk factors, people living with HIV (PLWHIV) have a 50-75% greater risk of acute myocardial infarction (AMI) than uninfected individuals. Several underlying causes for this association have been suggested including ongoing chronic inflammation, immune suppression, and a greater burden of anemia, renal disease, liver disease, and hepatitis C infection. While many of these factors have been studied in a cross-sectional manner, few have considered the association of cumulative HIV care measures with AMI among PLWHIV. We hypothesized that measuring these factors in a cumulative way would be associated with AMI incidence.

Methods: Retrospective cohort study including PLWHIV starting antiretroviral therapy (ART) in the Veterans Aging Cohort Study Virtual Cohort (VACS VC) from 2000-2009. The impact of baseline, time-updated and cumulative measures of HIV viremia, CD4 count and the VACS Index were modeled. Cumulative measures were captured starting 6 months after ART initiation until AMI event, death, last clinic visit or censor date (December 31, 2009) and calculated as follows:
1) Copy Years viremia (CYV)= Area under the curve of HIV viral load (VL) measures.
2) CD4 Years (CD4Y)= Area under the curve of CD4 measures.
3) VACS Index years (VISY)= Area under the VACS Index curve.
Areas under the curve were calculated using the trapezoidal rule. The VACS Index score was calculated using age, HIV-1 RNA, CD4, aspartate and alanine transaminases, hemoglobin, platelet count, creatinine and known hepatitis C infection. An online calculator is available (http://vacs.med.yale.edu). The primary outcome was incident AMI determined using Medicare and VA ICD9 codes. Multi-variable proportional hazard (PH) models were fit for time to AMI.

Results: 12,131 patients were included in the analysis. Separate PH models were fit for different measures of VL, CD4 and the VACS Index (basal, time-updated and cumulative) and results are presented in table 1. While all three cumulative measures predicted the studied outcome, VCY≥63, 000 copy-years/mL (HR=4.17; 95%CI=3.59-4.85) and CD4Y<750 cell-years/mm3 (HR=5.61; 95%CI=4.56-6.90); patients with higher VACS Index score-years had the highest risk of AMI (VISY≥250; HR=40.56; 95%CI=33.25-49.47).

Conclusions: Cumulative measures of viral load, CD4 count and VACS Index provide added information about risk of AMI, of these, VACS Index is the most comprehensive.

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Table 1. Multivariable Cox Proportional Hazards analyses of factors associated with time to Acute Myocardial Infarction among patients starting Initial ART regimens in the VACS Virtual Cohort; 2000-2009.

Session Number: 
P-P5
Session Title: 
Cardiovascular Risk Prediction
Presenting Author: 
Salinas, Jorge
Presenter Institution: 
Emory University
Poster: