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Factors Associated With Excess Myocardial Infarction Risk in HIV-Infected Adults

A Systematic Review and Meta-analysis

Rao, Shreya G., MDa; Galaviz, Karla I., PhDb; Gay, Hawkins C., MDc; Wei, Jingkai, MSPHd; Armstrong, Wendy S., MDe; del Rio, Carlos, MDb,f; Narayan, K.M. Venkat, MDb; Ali, Mohammed K., MDb

JAIDS Journal of Acquired Immune Deficiency Syndromes: June 1, 2019 - Volume 81 - Issue 2 - p 224–230
doi: 10.1097/QAI.0000000000001996
Clinical Science

Objectives: To estimate the pooled relative risk (RR) of incident acute myocardial infarction (AMI) among HIV-infected adults compared with HIV-uninfected controls and explore the contribution of traditional and HIV-related risk factors.

Background: Understanding AMI risk and associated risk factors in HIV-infected populations has the potential to inform clinical management and prevention strategies.

Methods: We systematically identified cohort studies of HIV-infected or HIV-infected and matched uninfected adults reporting AMI incidence rates published up to January 1, 2017. Random-effects meta-analysis models were used to estimate the aggregate RR of AMI by HIV status. Subgroup analysis and meta-regression were used to explore factors affecting risk.

Results: Sixteen studies (N = 1,619,690, median age 38.5 years, 78.9% male, mean follow-up of 6.5 years) were included. In pooled analyses of HIV-infected and matched uninfected cohorts (n = 5), HIV-infected individuals had higher AMI incidence rates (absolute risk difference = 2.2 cases per 1000 persons per year) and twice the risk of AMI [RR = 1.96 (1.5–2.6)] compared with matched HIV-uninfected controls. In a multivariate meta-regression, each additional percentage point in the proportion of male participants [odds ratio (OR) = 1.20 (1.14–1.27)] and each additional percentage point in the prevalence of hypertension [OR = 1.19 (1.12–1.27)], dyslipidemia [OR = 1.09 (1.07–1.11)], and smoking [OR = 1.09 (1.05–1.13)] were independently associated with increased AMI risk in HIV-infected adults.

Conclusions and Relevance: Chronic HIV infection is associated with a 2-fold higher AMI risk. Traditional risk factors such as hypertension, dyslipidemia, and smoking are significant contributors to AMI risk among HIV-infected adults and should be aggressively targeted in routine HIV care.

aDepartment of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX;

bHubert Department of Global Health, Emory University, Atlanta, GA;

cDepartment of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL;

dDepartment of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC;

eDepartment of Medicine, Emory University School of Medicine and Emory Center for AIDS Research, Atlanta, GA; and

fDepartment of Medicine and Emory Center for AIDS Research, Emory University, Atlanta, GA.

Corresponding author: Shreya G. Rao, MD, Division of Cardiology, University of Texas Southwestern Medical Center, 5233 Harry Hines Boulevard, Dallas, TX 75390 (e-mail:

S.G.R. and K.I.G. are to be co-first authors.

K.M.V.N. and M.K.A. were partially supported by the Georgia Center for Diabetes Translation Research (P30-DK-111024) funded by the National Institute of Diabetes and Digestive and Kidney Diseases. W.S.A. and C.d.R. were partially supported by the Emory Center for AIDS Research (P30AI050409) funded by the National Institute of Allergy and Infectious Diseases.

The authors have no funding or conflicts of interest to disclose.

S.G.R. performed the initial literature search and paper screening, data extraction, and drafted the manuscript. K.I.G. performed data analyses and drafted the manuscript. H.C.G. contributed to paper screening and edited the manuscript. J.W. helped with data analysis and edited the manuscript. C.d.R. and W.S.A. contributed to interpretation of findings and edited the manuscript. K.M.V.N. and M.K.A. designed the study, assisted with data analysis and interpretation of findings and helped draft the manuscript.

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Received October 08, 2018

Accepted January 28, 2019

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.