444. Current Protease Inhibitor Use, but not Cocaine Use or Depression, Remains Strongly Associated with Myocardial Infarction in the 2000ís in Inner City HIV-infected Patients: A Case-Control Study
Session: Poster Abstract Session: HIV Challenges and Complications
Friday, October 21, 2011
Room: Poster Hall B1
  • HIV MI poster.pdf (81.4 kB)
  • Background: HIV-infected individuals have high rates of myocardial infarction (MI). Traditional cardiovascular risk factors are clearly significant, but the role of antiretroviral therapy (ART) and HIV itself are still being evaluated.  Early protease inhibitors (PIs) were strongly associated with MI; the contribution of newer PIs is less well defined.  Additional risk factors, such as cocaine use and depression, are highly prevalent but inadequately explored.

    Methods: MIs among HIV+ patients followed at the Montefiore outpatient Center for Positive Living/ID Clinic were evaluated.  19 HIV+ patients with first MI between 2006-2009 were compared to 57 HIV+ clinic controls matched for age, year, and sex (including menopausal status).  All patients had standardized yearly comprehensive histories and screenings.  Traditional cardiovascular risk factors, end-stage renal disease (ESRD), CD4 counts, viral loads, and ART use, as well as nontraditional risk factors such as cocaine use, depression, and anxiety were examined.  Data was analyzed using SAS v9.1 software.

    Results: The average age of cases was 50 years; 58% were male.  Cocaine use was present in 12% of cases and 6% of controls.  Depression was present in 42% of cases and 40% of controls. Univariate analysis identified hypertension (p=0.05), ESRD (p=0.01), current NRTI use (p=0.05), current PI use (p<0.0001), current ART use (p<0.002), lower CD4 count (P=0.01), and lower CD4 nadir (p<0.005) as significant in cases.  In a multivariate analysis including all variables with a p value ≤0.20 (the above variables plus smoking, anxiety, and NNRTI use), only current PI use was significantly correlated with MI (OR = 11.3, 95% CI 2.9 – 43.6; p = 0.0005).

    Conclusion: Current PI use, even with newer generation PIs, remains independently associated with MI in HIV+ individuals, playing a greater role than traditional cardiovascular and other risk factors.  Cocaine use and depression were not associated with risk of MI in this small sample.  This analysis provides further evidence to support aggressive lowering of cardiovascular risk factors in PI-treated patients, and the increasing consideration of non-PI-containing regimens and new PI boosters without metabolic side effects.

    Subject Category: H. HIV/AIDS and other retroviruses

    Yehuda Cohen, MD1, Jonathan Shuter, MD2,3, Xuan Li, MS2 and Barry Zingman, MD1,2, (1)Montefiore Medical Center, Bronx, NY, (2)Albert Einstein College of Medicine, Bronx, NY, (3)Infectious Diseases, Montefiore Medical Center, Bronx, NY


    Y. Cohen, None

    J. Shuter, None

    X. Li, None

    B. Zingman, Pfizer: Grant Investigator, Research grant
    Merck/Schering-Plough: Grant Investigator, Research grant
    Roche: Grant Investigator, Research grant
    Tibotec: Grant Investigator, Research grant
    Gilead: Grant Investigator, Research grant
    ViiV/GlaxoSmithKline: Grant Investigator, Grant recipient

    Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.