Impact of HIV on treatment and outcome after acute myocardial infarction: a Swedish nationwide observational cohort study

Abstract

Abstract Background People living with HIV (PLHIV) on antiretroviral therapy (ART) have a higher risk of developing cardiovascular diseases (CVD) at a younger age due to chronic inflammation, higher prevalence of traditional cardiovascular risk factors and side-effects of ART – although the last is controversial. Moreover, recent studies have shown that PLHIV have unfavorable CVD outcomes compared to HIV-negative people. A potential explanation could be differences in acute treatment and in-hospital management. Purpose This study is aimed at investigating patients with and without HIV experiencing an acute myocardial infarction (AMI) in relation to baseline characteristics, in-hospital management and short-term outcomes. Methods The nationwide SWEDEHEART (The Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies) registry and Swedish National HIV Registry (InfCareHIV) were used to identify patients with and without HIV experiencing AMI. Primary outcome was the occurrence of a combined composite endpoint of major adverse cardiovascular events (MACE: all-cause mortality, new myocardial infarction or stroke) at 1 year in PLHIV versus HIV-negative people presenting with acute MI. Secondary outcomes were the occurrence of any of the individual components of the above composite endpoint. Kaplan-Meier survival curves and multivariable Cox regression models were used to compare the populations. Results We identified all PLHIV (n=319; 85% male) and HIV-negative people (n=711,506; 59% male) who experienced an AMI during 1996–2017 in Sweden. PLHIV presented with AMI more than ten years younger (median age 54.7 vs 67.1 years), had a higher prevalence of smoking and chewing tobacco use and a lower prevalence of hypertension. PLHIV with AMI had higher risks of MACE (adjusted hazard ratio (adjHR) for age, sex, traditional risk factors, comorbidities, in-hospital treatment and discharge medication = 1.60, 95% confidence interval (CI) 0.98–2.61) and mortality (adjHR = 2.37, 95% CI 1.34–4.16) at 1 year compared to HIV-negative people with AMI. Conclusion PLHIV suffer AMI more than 10 years earlier than HIV-negative people. HIV was independently associated with higher risk of MACE and more than doubled all-cause mortality at 1 year after AMI. Improved primary and secondary prevention (e.g. smoking cessation) may improve outcomes. Funding Acknowledgement Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): Fellowship Gilead Science, Public Health Agency of Sweden