HIV Infection and Long‐Term Residual Cardiovascular Risk After Acute Coronary Syndrome
Authors: Boccara Franck , Mary‐Krause Murielle , Potard Valérie , Teiger Emmanuel , Lang Sylvie , Hammoudi Nadjib , Chauvet Marion , Ederhy Stéphane , Dufour‐Soulat Laurie , Ancedy Yann , Nhan Pascal , Adavane Saroumadi , Steg Ph. Gabriel , Funck‐Brentano Christian , Costagliola Dominique , Cohen Ariel , Weber S. , Wahbi K. , Beaufils P. , Henri P. , Sideris G. , Thomas D. , Montalescot G. , Beygui F. , Meuleman C. , Janower S. , Raoux F. , Dufaitre G. , Benyounes N. , Michel P. L. , Petillon B. , Hammoudi N. , Gueret P. , Dubois‐Rande J. L. , Teiger E. , Lim P. , Slama M. , Colin P. , Saudubray C. , Dubourg O. , Milleron O. , Gallet B. , Duclos F. , Godard S. , Fuchs L. , Dormagen V. , Lewy P. , Cattan S. , Nallet O. , Grollier G. , Shayne J. , Wolf J. E. , Cottin Y. , Machecourt J. , Bouvaist H. , Finet G. , De Breyne B. , Trochu J. N. , Baudouy M. , Ferrari E. , Benhamou M. , Allal J. , Coisne D. , Le Breton H. , Bedossa M. , Puel J. , Elbaz M. , Larifla L. , Matheron S. , Landman R. , Fremont G. , Spiridon G. , Blanche P. , Morini J. P. , Sicard D. , Zeller V. , Batisse D. , Clevenbergh P. , Cessot G. , Dohin E. , Valantin M. A. , Khelifa S. , Girard P. M. , Lallemand F. , Lefebvre B. , Laporte J. P. , Meynard J. L. , Bideault H. , Picard O. , Meyohas M. C. , Campa P. , Tredup J. , Fonquernie L. , Raguin G. , Molina J. M. , Furco A. , Gharakanian S. , Vincensini J. P. , Guiard‐Schmid J. B. , Pialoux G. , Cardon B. , Lascaux A. S. , Chaix F. , Lesprit P. , Fior R. , Boue F. , Dupont C. , Bellier C. , Blanc A. , Lambert T. , Touahri T. , Force G. , de Truchis P. , Compagnucci‐Seguenot M. A. , Cahitte I. , Roudière L. , Techer M. E. , Thelpin P. , Troisvallets D. , Lepretre A. , Echard M. , Le Mercier Y. , Houlbert D. , Dargere S. , Bazin C. , Verdon R. , De Goer B. , Duong M. , Chavanet P. , Gozlan E. , Leclercq P. , Brunel‐Dal Mas F. , Durant J. , Heudier P. , Brunet‐François C. , Le Moal G. , Chapplin J. M. , Arvieux C. , Chaumentin G. , Guerin B. , Bonnet E. , Poinsignon Y. , Boulard F. , De Lacroix I. , Goerger‐Sow M. T. , Kirstetter M. , Volstein M. , Laylavoix F. , Copin X. , Ceppi C. 
Published: August 2020

Background

It is unclear whether HIV infection affects the long‐term prognosis after an acute coronary syndrome (ACS). The objective of the current study was to compare rates of major adverse cardiac and cerebrovascular events after a first ACS between people living with HIV (PLHIV) and HIV‐uninfected (HIV−) patients, and to identify determinants of cardiovascular prognosis.

Methods and Results

Consecutive PLHIV and matched HIV− patients with a first episode of ACS were enrolled in 23 coronary intensive care units in France. Patients were matched for age, sex, and ACS type. The primary end point was major adverse cardiac and cerebrovascular events (cardiac death, recurrent ACS, recurrent coronary revascularization, and stroke) at 36‐month follow‐up. A total of 103 PLHIV and 195 HIV− patients (mean age, 49 years [SD, 9 years]; 94.0% men) were included. After a mean of 36.6 months (SD, 6.1 months) of follow‐up, the risk of major adverse cardiac and cerebrovascular events was not statistically significant between PLHIV and HIV− patients (17.8% and 15.1%,
P
=0.22; multivariable hazard ratio [HR], 1.60; 95% CI, 0.67–3.82 [
P
=0.29]). Recurrence of ACS was more frequent among PLHIV (multivariable HR, 6.31; 95% CI, 1.32–30.21 [
P
=0.02]). Stratified multivariable Cox models showed that HIV infection was the only independent predictor for ACS recurrence. PLHIV were less likely to stop smoking (47% versus 75%;
P
=0.01) and had smaller total cholesterol decreases (–22.3 versus –35.0 mg/dL;
P
=0.04).

Conclusions

Although the overall risk of major adverse cardiac and cerebrovascular events was not statistically significant between PLHIV and HIV− individuals, PLHIV had a higher rate of recurrent ACS.

Registration

URL:
https://www.clini​caltr​ials.gov
; Unique identifier: NCT00139958.