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Associations between immune depression and cardiovascular events in HIV infection

(2013) AIDS. 27(17). p.2735-2748
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Abstract
Objective: To consider associations between the latest/nadir CD4(+) cell count, and time spent with CD4(+) cell count less than 200cells/l (duration of immune depression), and myocardial infarction (MI), coronary heart disease (CHD), stroke, or cardiovascular disease (CVD) (CHD or stroke) in 33301 HIV-positive individuals.Design:Longitudinal cohort study. Methods: Analyses were undertaken using Poisson regression. To investigate whether analyses of stroke were robust to the type of endpoint, we additionally included stroke-like events and rejected strokes into the stroke endpoint. Results: Participants experienced 716 MI, 1056 CHD, 303 stroke, and 1284 CVD events. Whereas there was no evidence of a higher MI/CHD risk in those with lower latest/nadir CD4(+) cell counts after adjustment [current CD4(+)<100cells/l: relative rate (95% confidence interval) 0.96 (0.62-1.50) for MI, 0.89 (0.30-2.36) for CHD; nadir CD4(+)<100cells/l: 1.36 (0.57-3.23) for MI, 0.98 (0.45-2.16) for CHD], stroke and CVD rates were higher in those with a latest CD4(+) cell count less than 100cells/l [2.26 (1.29-3.94) and 1.14 (0.84-1.56), respectively]. All events occurred less frequently in those who had not experienced immune depression, although evidence for a linear association with duration of immune depression was weak. The association between stroke risk and the latest CD4(+) cell count strengthened as stroke-like and rejected strokes were included; conversely, associations with established stroke risk factors weakened. Conclusion: We do not find strong evidence that HIV-positive individuals with a low CD4(+) cell count are more likely to experience MI/CHD. Although strokes appear to occur more commonly at low CD4(+) cell counts, this may be partly explained by misclassification or other biases.
Keywords
myocardial infarction, CD4(+) lymphocyte count, stroke, COMBINATION ANTIRETROVIRAL THERAPY, MYOCARDIAL-INFARCTION RATES, CORONARY-HEART-DISEASE, T-CELL COUNTS, METABOLIC SYNDROME, RISK-FACTORS, INDEPENDENT PREDICTORS, CEREBROVASCULAR EVENTS, DIABETES-MELLITUS, ATHEROSCLEROSIS, bias, cardiovascular disease

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Citation

Please use this url to cite or link to this publication:

Chicago
Sabin, Caroline A, Lene Ryom, Stephane De Wit, Amanda Mocroft, Andrew N Phillips, Signe W Worm, Rainer Weber, et al. 2013. “Associations Between Immune Depression and Cardiovascular Events in HIV Infection.” Aids 27 (17): 2735–2748.
APA
Sabin, C. A., Ryom, L., De Wit, S., Mocroft, A., Phillips, A. N., Worm, S. W., Weber, R., et al. (2013). Associations between immune depression and cardiovascular events in HIV infection. AIDS, 27(17), 2735–2748.
Vancouver
1.
Sabin CA, Ryom L, De Wit S, Mocroft A, Phillips AN, Worm SW, et al. Associations between immune depression and cardiovascular events in HIV infection. AIDS. 2013;27(17):2735–48.
MLA
Sabin, Caroline A, Lene Ryom, Stephane De Wit, et al. “Associations Between Immune Depression and Cardiovascular Events in HIV Infection.” AIDS 27.17 (2013): 2735–2748. Print.
@article{4350951,
  abstract     = {Objective: To consider associations between the latest/nadir CD4(+) cell count, and time spent with CD4(+) cell count less than 200cells/l (duration of immune depression), and myocardial infarction (MI), coronary heart disease (CHD), stroke, or cardiovascular disease (CVD) (CHD or stroke) in 33301 HIV-positive individuals.Design:Longitudinal cohort study.
Methods: Analyses were undertaken using Poisson regression. To investigate whether analyses of stroke were robust to the type of endpoint, we additionally included stroke-like events and rejected strokes into the stroke endpoint.
Results: Participants experienced 716 MI, 1056 CHD, 303 stroke, and 1284 CVD events. Whereas there was no evidence of a higher MI/CHD risk in those with lower latest/nadir CD4(+) cell counts after adjustment [current CD4(+)<100cells/l: relative rate (95% confidence interval) 0.96 (0.62-1.50) for MI, 0.89 (0.30-2.36) for CHD; nadir CD4(+)<100cells/l: 1.36 (0.57-3.23) for MI, 0.98 (0.45-2.16) for CHD], stroke and CVD rates were higher in those with a latest CD4(+) cell count less than 100cells/l [2.26 (1.29-3.94) and 1.14 (0.84-1.56), respectively]. All events occurred less frequently in those who had not experienced immune depression, although evidence for a linear association with duration of immune depression was weak. The association between stroke risk and the latest CD4(+) cell count strengthened as stroke-like and rejected strokes were included; conversely, associations with established stroke risk factors weakened.
Conclusion: We do not find strong evidence that HIV-positive individuals with a low CD4(+) cell count are more likely to experience MI/CHD. Although strokes appear to occur more commonly at low CD4(+) cell counts, this may be partly explained by misclassification or other biases.},
  author       = {Sabin, Caroline A and Ryom, Lene and De Wit, Stephane and Mocroft, Amanda and Phillips, Andrew N and Worm, Signe W and Weber, Rainer and Monforte, Antonella D'Arminio and Reiss, Peter and Kamara, David and El-Sadr, Wafaa and Pradier, Christian and Dabis, François and Law, Matthew and Lundgren, Jens and D:A:D Study group, the and Vandekerckhove, Linos},
  issn         = {0269-9370},
  journal      = {AIDS},
  keywords     = {myocardial infarction,CD4(+) lymphocyte count,stroke,COMBINATION ANTIRETROVIRAL THERAPY,MYOCARDIAL-INFARCTION RATES,CORONARY-HEART-DISEASE,T-CELL COUNTS,METABOLIC SYNDROME,RISK-FACTORS,INDEPENDENT PREDICTORS,CEREBROVASCULAR EVENTS,DIABETES-MELLITUS,ATHEROSCLEROSIS,bias,cardiovascular disease},
  language     = {eng},
  number       = {17},
  pages        = {2735--2748},
  title        = {Associations between immune depression and cardiovascular events in HIV infection},
  url          = {http://dx.doi.org/10.1097/01.aids.0000432457.91228.f3},
  volume       = {27},
  year         = {2013},
}

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