Previous studies of cardiovascular disease (CVD) among HIV-infected individuals have been limited by the inability to validate and differentiate atherosclerotic type 1 myocardial infarctions (T1MIs) from other events. We sought to define the incidence of T1MIs and risk attributable to traditional and HIV-specific factors among participants in the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD), and compare adjusted incidence rates to the general population Atherosclerosis Risk in Communities (ARIC) cohort.
We ascertained and adjudicated incident MIs among individuals enrolled in seven NA-ACCORD cohorts between 1995–2014. We calculated incidence rates (IR), adjusted incidence rate ratios (aIRRs), and 95% confidence intervals ([,]) of risk factors for T1MI using Poisson regression. We compared aIRRs of T1MIs in NA-ACCORD with those from ARIC.
Among 29,169 HIV-infected individuals, the IR for T1MIs was 2.57[2.30–2.86] per 1000 person-years, and the aIRR was significantly higher compared with participants in ARIC (1.30[1.09–1.56]). In multivariable analysis restricted to HIV-infected individuals and including traditional CVD risk factors, the rate of T1MI increased with decreasing CD4 count (≥500 cells/μL: ref; 350–499 cells/μL: aIRR=1.32[0.98–1.77]; 200–349 cells/μL: aIRR=1.37[1.01–1.86]; 100–199 cells/μL: aIRR=1.60[1.09–2.34]; <100 cells/μL: aIRR=2.19[1.44–3.33]). Risk associated with detectable HIV RNA (<400 copies/mL: ref; ≥400 copies/mL: aIRR=1.36 [1.06–1.75]) was significantly increased only when CD4 was excluded.