Trends in the risk of myocardial infarction among HIV-1-infected individuals relative to the general population in France: Impact of gender and immune status.

Aliou Baldé,Jean-Michel Molina,Pierre-Marie Roger,Dominique Costagliola,Jean-Luc Meynard,Franck Boccara,Marialuisa Partisani,Laurent Cotte,Sylvie Lang,Aline Wagner,Elisabeth Aslangul,Pierre Tattevin,Frédéric Bidégain,Jean Ferrières,Michèle Montaye,Antoine Chéret,Murielle Mary-Krause

doi:10.1371/journal.pone.0210253

Abstract

We examined trends in the MI incidence and age at MI diagnosis among adults living with HIV-1 between 2000 and 2009, by comparison with the French MI registries, by gender. Age standardized incidence rates and standardized incidence-ratios (SIRs) were estimated for individuals included in the French hospital database on HIV (n = 71 204, MI = 663) during three periods: 2000–2002, 2003–2005 and 2006–2009. Median ages at MI diagnosis were compared using the Brown-Mood test. Over the study periods, the absolute rate difference and relative risks were higher in women than in men in 2000–2002 and 2006–2009, with respective SIRs 1.99 (1.39–2.75) and 1.12 (0.99–1.27) in 2006–2009. The trends were different for men and women with a decreasing trend in SIRs in men and no change in women. In both sexes, among individuals with CD4 ≥500/μL and controlled viral-load on cART, the risk was no longer elevated. Age at MI diagnosis was significantly younger than in the general population, especially among women (-6.2 years, p<0.001; men: -2.1 years, p = 0.02). In HIV-1-positive adults, absolute rate difference and relative risks and trends of MI were different between men and women and there was no additional risk among individuals on effective cART.

Highlights

Previous studies have shown a higher risk of myocardial infarction (MI) among people living with HIV (PLHIV) than in the general population [1,2,3,4]
Relative to the male general population, the risk of MI in male co-infected with hepatitis C were significant and did not decrease across calendar period with a standardized incidence-ratios (SIRs) of 2.04 in 2006– 2009
The relative risk of MI and trend across calendar period in men non co-infected with hepatitis C were similar to those previously found in HIV-infected men with a SIR of 1.04 in 2006–2009

Summary

Introduction

Previous studies have shown a higher risk of myocardial infarction (MI) among people living with HIV (PLHIV) than in the general population [1,2,3,4]. The relative risk of MI was higher in HIV-infected women than in men in the only two studies reporting analyses of the risk by gender [1, 3]. Analyses of the Kaiser Permanente database showed that the risk of MI was lower when the current CD4 cell count was 500/μL than when it was

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