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CDC HIV/AIDS/Viral Hepatitis/STD/TB Prevention News Update
Coronary Heart Disease in HIV-Infected Individuals
Judith S. Currier, MD, MSc; Anne Taylor, MD; Felicity Boyd,
October 28, 2003
Journal of Acquired Immune Deficiency Syndromes (08.01.03)

The current study examined the age-specific incidence of coronary heart disease (CHD) among HIV-infected and noninfected men and women in the California Medicaid population. The authors reviewed administrative claims data and compared the incidence of and relative risk for CHD using log-linear analyses. They also assessed the association between exposure to antiretroviral therapy (ART) and CHD incidence.

Of the 3,083,209 individuals analyzed, 28,513 had HIV. In that cohort, 20,742 (72.7 percent) were men. The researchers captured a total of 235,881 CHD diagnoses in the total population, 1,306 of which came from the HIV-infected group. Coronary atherosclerosis was the most common diagnosis, followed by angina pectoris and myocardial infarction.

"Compared with their non-HIV-infected male counterparts in the Medi-Cal population," the investigators wrote, "CHD incidence among HIV-infected men was significantly higher in the age categories of 18-24 years. ...Compared with their non-HIV- infected female counterparts, CHD incidence among HIV-infected women was significantly higher among those aged 18-24 years and 35-44 years. CHD incidence among HIV-infected women older than 44 years was lower than that among the Medi-Cal reference group." Controlling for recognized CHD risk factors - diabetes, hyperlipidemia, renal failure and hypertension - the analysts divided patients into those exposed to ART and those never exposed to ART. Fifty-two percent of 18- to 33-year-olds, 68 percent of 34- to 49-year-olds, 61 percent of 50- to 65-year- olds and 30 percent of those 66 and older had been exposed to ART. "The covariate-adjusted RR [relative risk] for the development of CHD in individuals receiving ART compared with those not receiving ART was 2.06," the analysts found, "in HIV-infected individuals aged 18-33 years. There were no statistically significant associations between ART exposure and CHD in other age groups." "These results help to frame the benefits of highly active ART in the context of possible CHD risk and suggest that the timing of aggressive cardiovascular risk assessment and management may need to be considered at younger ages for this high-risk subset of patients," the authors suggested. "Strategies to reduce CHD risk should be incorporated into HIV primary care."