Abstract
Purpose: The PACS-HIV study was designed to determine the 3-year prognosis of acute coronary syndrome (ACS) in HIV-infected patients (HIV+) as compared to HIV- in a prospective observational study. We report the cardiovascular risk profile after the index ACS. Methods: We enrolled 103 HIV-infected and 195 HIV-uninfected patients with a first episode of ACS matched for age (± 5 years), sex, and type of ACS. During follow up, cardiovascular risk factors including lipid parameters, tobacco consumption were collected. Univariate conditional logistic regression was used to compare variables and stratified multivariate Cox models were performed. Results: The mean age at enrolment was 49.0 ± 9.4 years and 94% were men. At admission, coronary risk factors were well balanced between the 2 groups except for a higher rate of illicit drug used and hypertriglyceridaemia in the HIV+ group. At 3-year follow up, HIV+ patient exert a higher rate of recurrent ACS as compared with HIV- patients (univariate HR 3.4; 95% CI [1.3-8.8]). At long term, HIV+ exhibit a worse cardiovascular risk profile with more smokers and worse atherogenic lipid profile (Table). Incident cases of hypertension and diabetes tend to be higher in the HIV+ group (16.2/1000 persons per year (PY) vs 9.1/1000 PY, RR (HIV+ / HIV-)=1.8, IC 95% =[0.4-7.1] 41.0/1000 PY vs 21.9/1000PY, RR (HIV+ / HIV-)=1.9, IC 95% =[0.8-4.3], respectively). Stratified multivariable Cox model showed that HIV status, total cholesterol and LDLc were associated with the recurrence of ACS (Table). Conclusions: At long-term follow-up after ACS, HIV+ exhibit higher residual cardiovascular risk. HIV infection and atherogenic lipid profile were associated with an increased risk of ACS. Secondary prevention should focus on smoking cessation and strict LDL goal in HIV+. Table. Cardiovascular risk factors at 3-year follow Multivariate analysis associated with increased risk of recurrent ACS Values expressed as n (%) , *time-dependent covariates
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