Impact of HIV on Treatment and Outcome After Acute Myocardial Infarction: A Swedish Nationwide Observational Cohort Study

Abstract

Background: People living with HIV (PLHIV) on antiretroviral treatment (ART) may have unfavourable cardiovascular outcomes compared to people without HIV. A potential explanation could be differences in acute treatment and in-hospital management. This study aimed to compare patients with and without HIV experiencing an acute myocardial infarction (MI) in relation to baseline characteristics, treatment, and cardiovascular outcomes. \n \nMethods:\xa0Two Swedish disease registry cohorts were used to identify patients with and without HIV experiencing MI. The primary outcome was the occurrence of a combined composite endpoint of major adverse cardiovascular events (MACE: reinfarction, stroke, or all-cause mortality) within 5 years in PLHIV versus patients without HIV presenting with MI. Cox regression models were used to compare populations. \n \nFindings:\xa0We identified all PLHIV (n=191; 89% male) and people without HIV (n=324,635; 64% male) who experienced a MI during 1996–2017 in Sweden. PLHIV presented with MI more than 15 years earlier (median age 55 vs 72 years), had a higher prevalence of smoking, and a lower prevalence of hypertension. PLHIV with MI had higher risks of MACE (adjusted hazard ratio (aHR) 2·01 [1·56-2·58]), reinfarction (aHR 2·06 [1·46–2·91]), stroke (aHR 2·00 [1·11–3·62]), and all-cause\xa0mortality (aHR 2·07 [1·45–2·94]) at 5 years. \n \nInterpretation:\xa0HIV was independently associated with higher risk of MACE and more than doubled the risk of all-cause mortality at 5 years after MI. This study indicates that HIV is an independent risk factor for worse outcomes following MI.\xa0 \n \nFunding Information: This work was supported by a Gilead Science Fellowship and the Public Health Agency of Sweden to GM. \n \nDeclaration of Interests: Dr. Jernberg reports grants from MSD, grants from Novartis, and that his employer has received reimbursement from Astra Zeneca, Bayer, MSD, Novartis and Sanofi for lecturing. Dr. Elvstam reports grants from Pfizer, outside the submitted work. The other authors declare that there is no conflict of interest. \n \nEthics Approval Statement: The study is ethically approved by the ethical review board of Stockholm, Sweden (reference number: 2018/1957-32). The ethical review board waived the need for consent for this study.