Ischemic Heart Disease in HIV-Infected and HIV-Uninfected Individuals: A Population-Based Cohort Study

• Published in: Clinical infectious diseases Vol. 44; no. 12; pp. 1625 - 1631
• Main Authors: Obel, Niels, Thomsen, Henrik F., Kronborg, Gitte, Larsen, Carsten S., Hildebrandt, Per R., Sørensen, Henrik T., Gerstoft, Jan
• Format: Journal Article
• Language: English
• Published: Chicago, IL The University of Chicago Press 15.06.2007; University of Chicago Press; Oxford University Press
• Subjects: Adult; AIDS; Antiretroviral drugs; Antiretroviral Therapy, Highly Active - adverse effects; Antiretrovirals; Biological and medical sciences; Cardiology. Vascular system; Cardiovascular disease; Clinical outcomes; Cohort Studies; Comorbidity; Coronary heart disease; Denmark; Disease risk; Drug therapy; Female; Heart; Highly active antiretroviral therapy; HIV; HIV infections; HIV Infections - complications; HIV/AIDS; Hospitalization; Hospitalization - statistics & numerical data; Hospitalization - trends; Human immunodeficiency virus; Human subjects; Human viral diseases; Humans; Infections; Infectious diseases; Kaplan-Meier Estimate; Male; Medical sciences; Myocardial infarction; Myocardial ischemia; Myocardial Ischemia - complications; Myocardial Ischemia - epidemiology; Myocardial Ischemia - virology; Myocarditis. Cardiomyopathies; Protease inhibitors; Retrospective Studies; Risk; Risk factors; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Denmark; Immunopathology; Retroviridae; Cardiovascular disease; Myocardial ischemia; AIDS; Immune deficiency; Lentivirus; Myocardial disease; Coronary heart disease; Infection; Vascular disease; Virus; Viral disease; Cohort study; Human immunodeficiency virus
• ISSN: 1058-4838; 1537-6591; 1537-6591
• DOI: 10.1086/518285

Background. There are concerns about highly active antiretroviral therapy (HAART) causing a progressive increase in the risk of ischemic heart disease. We examined this issue in a nationwide cohort study of patients with human immunodeficiency virus (HIV) infection and a population-based control group. Methods. We determined the rate of first hospitalization for ischemic heart disease in all Danish patients with HIV infection (3953 patients) from 1 January 1995 through 31 December 2004 and compared this rate with that for 373,856 subjects in a population-based control group. Data on first hospitalization for ischemic heart disease and comorbidity were obtained from the Danish National Hospital Registry for all study participants. We used Cox's regression to compute the hospitalization rate ratio as an estimate of relative risk, adjusting for comorbidity. Results. Although the difference was not statistically significant, patients with HIV infection who had not initiated HAART were slightly more likely to be hospitalized for the first time with ischemic heart disease than were control subjects (adjusted relative risk, 1.39; 95% confidence interval, 0.81–2.33). After HAART initiation, the risk increase became substantially higher (adjusted relative risk, 2.12; 95% confidence interval, 1.62–2.76), but the relative risk did not further increase in the initial 8 years of HAART. Conclusions. Compared with the general population, HIV-infected patients receiving HAART have an increased risk of ischemic heart disease, but the relative risk is stable up to 8 years after treatment initiation.