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Home >> Publications >> Associations between immune depression and cardiovascular events in HIV infection.

Publication

Author(s):

Sabin CA, Ryom L, De Wit S, Mocroft A, Phillips AN, Worm SW, Weber R, D'Arminio Monforte A, Reiss P, Kamara D, El-Sadr W, Pradier C, Dabis F, Law M, Lundgren J; D:A:D Study Group.

Pub Title:

Associations between immune depression and cardiovascular events in HIV infection.

Pub Date:

Nov 13 2013

Pub Region(s):

Asia-Pacific

Journal:

Title: 
AIDS
Link: 
http://ovidsp.tx.ovid.com/sp-3.11.0a/ovidweb.cgi?QS2=434f4e1a73d37e8c740ce3cde7a3378540d19a84ae25a6655df53daf433739fb45e753332199c271cbea0609ee1730267007aabfd52e5508e7e84e3e7359e290ec3e45dbdbfbd8f2d69994ebe544bf50764ba1436d946da356b4a1f2150933ab5e5a0abc9b

PubMed: 23842128
Pub PDF:

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.

ETHODS: 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.

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Citation:

Sabin CA, Ryom L, De Wit S, Mocroft A, Phillips AN, Worm SW, Weber R, D'Arminio Monforte A, Reiss P, Kamara D, El-Sadr W, Pradier C, Dabis F, Law M, Lundgren J; D:A:D Study Group. Associations between immune depression and cardiovascular events in HIV infection. AIDS. 2013 Nov 13;27(17):2735-48. doi: 10.1097/01.aids.0000432457.91228.f3. PubMed PMID: 23842128.