Abstract 060: Contribution of Immunodeficiency to Coronary Heart Disease: Cohort Study of HIV-infected and HIV-uninfected Kaiser Permanente Members

Abstract

Background: We compared CHD rates among HIV+ and HIV- patients in a large integrated care system, to explore the role of immunodeficiency in CHD. Methods: Kaiser Permanente (KP) California serves >6 million members. Using previously described databases, we matched adult HIV+ members to HIV- members (1:10 ratio) on age, sex, medical center and year of start of follow-up. We searched hospitalization records to identify members with discharge diagnoses codes [MH1] ICD-9: 410x-411x, 413x-414x. The cohort was followed from first KP enrollment after 1996 until earliest recorded CHD event, death, KP disenrollment, or 12/31/2009. We stratified HIV+ members by antiretroviral therapy (ART) use, recent and lowest KP-recorded CD4, and compared rates with HIV- KP members. We obtained rate ratios (RRs) for any CHD diagnosis and MIs from Poisson regression models adjusting for age, sex, race, tobacco use, alcohol/drug abuse, obesity, diabetes, use of lipid lowering, and hypertension therapy. An additional analysis of only HIV+ individuals examined the effects of antiretroviral therapy use, recent HIV RNA, and recent and nadir CD4 on CHD.[MH2] Results: 22,081 HIV+ and 215,158 HIV- members contributed 101,044 pys and 1,265,819 pys respectively. HIV+ had 446 CHD events (including 280 MIs), corresponding to a rate of 451/100,000 py. HIV- had 3,926 CHD events (including 2,064 MIs), corresponding to a rate of 316 cases/100,000 py. The adjusted CHD RR for HIV status was 1.4 (95% CI: 1.3-1.6; p<0.001), and the adjusted MI RR was 1.7 (95% CI: 1.5-1.9; p<0.001). CHD RRs for HIV+ as stratified by ART use and CD4 level are shown in Table (with HIV- as reference). Table. Adjusted rate ratios * for CHD among HIV+ individuals by recent and lowest CD4 Recent CD4 Lowest KP CD4 RR (95% CI) p value RR (95% CI) p value ART+, CD4 ≥500 0.9 (0.7, 1.1) 0.218 0.8 (0.5, 1.2) 0.231 ART+, CD4 201-499 1.4 (1.2, 1.6) <0.001 1.1 (0.9, 1.3) 0.300 ART+, CD4 ≤200 1.8 (1.4, 2.2) <0.001 1.4 (1.3, 1.6) <0.001 ART-, CD4 ≥500 1.3 (0.9, 1.9) 0.213 1.3 (0.8, 2.1) 0.363 ART-, CD4 201-499 1.1 (0.7, 1.7) 0.671 1.3 (0.9, 1.8) 0.182 ART-, CD4 ≤200 1.8 (0.9, 3.8) 0.113 1.1 (0.6, 2.2) 0.778 * HIV- as reference for all RRs Conclusions: Adjusting for traditional risk factors, HIV+ individuals have a statistically significant increased risk for cardiovascular complications. Aggressive attention to modifiable risk factors is particularly important. As increased CHD risk was not seen for patients with relatively preserved CD4, earlier initiation of ART may further reduce CHD [. l