Cardiovascular disease in human immunodeficiency virus infected patients: A true or perceived risk?

Table 1 Epidemiological studies evaluating the impact of human immunodeficiency virus on cardiovascular disease

Ref.	Size	Follow-up	Findings
Freiberg et al[6]	82459 27350 HIV+ 55109 HIV-	5.9 yr	Increased risk of MI among HIV+ patients VACS-VS study[6] (HR: 1.48; 95%CI: 1.27-1.72)
Womack et al[9] VACS-VS study	2187 women 32% HIV+	6 yr	Increased risk of CVD in HIV+ women compared to uninfected women (HR: 2.8; 95%CI: 1.7-4.6)
Paisible et al[10] VACS-VS study	81322 33% HIV+	5.9 yr	HIV+ veterans without major CVD risk factors had a 2-fold increased risk of MI compared with HIV- veterans without CVD risk factors (HR: 2.0; 95%CI: 1.0- 3.9)
Triant et al[11]	3851 HIV+ 1044589 HIV-	8 yr	Increased risk of MI among HIV+ patients (RR: 1.75; P < 0.0001)
Silverberg et al[12]	22081 HIV+ 23069 HIV-	13 yr	Higher risk of MI among HIV+ patients with a low recent or nadir CD4 cells (< 200) compared with HIV- subjects (RR, 1.76; 95%CI: 1.31-2.37 for low recent CD4 RR, 1.74; 95%CI: 1.47-2.06 for low nadir CD4)
Lang et al[13] FHDH-ANRS CO4	74958 HIV+	6 yr	The risk of MI was higher in both HIV+ men and women compared with the general population Standardized mortality ratio: 1.4 (95%CI: 1.3-1.6) for HIV+ men and 2.7 (95%CI: 1.8 -3.9) for HIV+ women compared with the general population
Hsue et al[14]	148 HIV+ 63 HIV-	1 yr	Higher baseline carotid IMT of HIV+ patients (P = 0.0001) and faster progression (P = 0.002)
Currier et al[17]	133 subjects in 45 triads1	144 wk	HIV infection and PI use did not contribute to the rate of carotid IMT progression. The median paired difference in IMT change between the PI and non-PI subjects was not statistically significant (P = 0.19). When the HIV+ groups were combined and compared with the HIV-negative group, the difference in progression was also not significant (P = 0.71)
Post et al[18]	618HIV+ 383HIV- men cross-sectional study		HIV-infected men had a greater prevalence of CAC [PR: 1.21 (95%CI: 1.08); P = 0.001] and any plaque [PR: 1.14 (CI: 1.05- 1.24); P = 0.001], including non-calcified [PR: 1.28 (CI: 1.13-1.45); P < 0.001) and mixed [PR: 1.35 (CI: 1.10-1.65); P = 0.004) plaque, than uninfected men
Klein et al[19] VACS-VS study	95687 31% HIV+	15 yr	Decline in adjusted MI rate ratio for HIV status over time, reaching 1 (95%CI: 7-1.4) in 2010-2011

¹Each triad consisted of one subject from each of the following categories: (1) HIV+ with continuous PI therapy; (2) HIV+ without prior PI use; (3) HIV- subject. HIV: Human immunodeficiency virus; IMT: Intima-media thickness; MI: Myocardial infarction; PR: Prevalence ratio; CVD: Cardiovascular disease.

Table 2 Crude and adjusted rate ratios (95%CI) of myocardial infarction comparing human immunodeficiency virus infected and uninfected patients during a 13-year time span in the California Kaiser Permanente health system

Year	1996-2011	1996-1999	2000-2003	2004-2007	2008-2009	2010-2011
Crude	1.6 (1.5, 1.8)	2.0 (1.5, 2.8)	2.0(1.6, 2.5)	1.5 (1.2, 1.9)	1.5 (1.1-2.0)	1.2 (0.9-1.6)
Adjusted	1.4 (1.2, 1.6)	1.8 (1.3, 2.6)	1.7(1.4, 2.1)	1.3 (1.0, 1.6)	1.3 (0.9, 1.7)	1.0 (0.7, 1.4)

Modified from Klein et al[19].