Acute Coronary Syndromes in Human Immunodeficiency Virus Patients: A Meta-Analysis Investigating Adverse Event Rates and the Role of Antiretroviral Therapy

Jan 06, 2012
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Authors:
D’Ascenzo F, Cerrato E, Biondi-Zoccai G, et al.
Citation:
Eur Heart J 2011;Dec 20:[Epub ahead of print].
Summary By:
Melvyn Rubenfire, MD, FACC

Study Questions:

Highly active antiretroviral therapy (HAART) dramatically reduces human immunodeficiency virus (HIV)-associated morbidity and mortality, but adverse effects of HAART are becoming an increasing challenge, especially in the setting of acute coronary syndromes (ACS). What is the impact of HAART on ACS in HIV patients?

Methods:

MEDLINE/PubMed was systematically screened for studies reporting on ACS in HIV patients. Baseline, treatment, and outcome data were appraised and pooled with random-effect methods computing summary estimates.

Results:

A total of 11 studies including 2,442 patients were identified, with a low prevalence of diabetes (11%). Rates of in-hospital death were 8.0%, ascribable to cardiovascular events in 7.9%, with 2.31% developing cardiogenic shock. At a median follow-up of 26 months, no deaths were recorded, with an incidence of 9.42% of acute myocardial infarction (AMI), and 20.18% underwent percutaneous coronary intervention. Pooled analysis of the studies reporting incidence of AMI in patients exposed to protease inhibitors showed an overall significant risk of 2.68 (odds ratio, 1.89; 3.89; 95% confidence interval).

Conclusions:

The authors concluded that HIV patients admitted for ACS face a substantial short-term risk of death and a significant long-term risk of coronary revascularization and MI, especially if receiving protease inhibitors.

Perspective:

Coronary disease is the third most common cause of death in HIV. HIV infection and antiretroviral therapy can play a role in the risk of plaque rupture and atherothrombosis. The metabolic syndrome and smoking are common in HIV, and the virus may affect cholesterol processing and transport. HIV guidelines include treating risk factors, but caution is needed considering the interactions between most statins and HIV therapies.

Keywords: Antiretroviral Therapy, Highly Active, Acute Coronary Syndrome, Morbidity, HIV Infections


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