1393. Rhabdomyolysis in HIV-infected versus HIV-uninfected Persons Enrolled in Kaiser Permanente California
Session: Oral Abstract Session: Complications of HIV
Sunday, October 23, 2011: 8:00 AM
Room: 151AB
Background:  There is little data on risk for rhabdomyolysis (RM) in HIV+ persons when compared with matched HIV- persons.

Methods:  We conducted a cohort study from 1996-2008 of adult HIV+ (N=20,775) and age/gender-matched HIV- persons (N=215,158) within Kaiser Permanente (KP).  RM cases were identified by inpatient diagnoses of RM accompanied by creatinine kinase (CK) >10x upper limits normal (ULN) within 7 days of admission.  We also included all elevated outpatient CKs >10x ULN.  For both inpatient and outpatient diagnoses we excluded those patients with an MI within seven days of the CK measurement.  Chart review on a random sample confirmed the accuracy of our case definition. Using Poisson regression, we compared the risk of RM between HIV+ persons (stratified by ART use and both current and lowest recorded CD4 in KP) with HIV- persons (reference), adjusting for race/ethnicity, smoking, alcohol/drug abuse, diabetes, and lipid-lowering therapy.  A second model of only HIV+ persons also evaluated other HIV specific risk factors, including HIV exposure risk, HIV RNA levels and ART class.

Results:  We observed 238 RM cases among HIV+ persons (265 events/100,000 py) and 297 RM cases among HIV- persons (26 events/100,000 py); adjusted overall rate ratio (RR)=10.1 (95% CI: 8.5-12.0; p<0.001). 


Adjusted Rate Ratios (RR) (Reference Group for all RR are HIV-)



Recent CD4


Lowest Recorded CD4



(95% CI)




(95% CI)


ART+, CD4 ≥500


(4.0, 7.0)

< 0.001



(2.6, 8.2)

< 0.001

ART+, CD4 201-499


(5.9, 9.5)

< 0.001



(4.9, 8.4)

< 0.001

ART+, CD4 ≤200


(8.5, 15.7)

< 0.001



(6.7, 10.4)

< 0.001

ART-, CD4 ≥500


(2.2, 7.5)

< 0.001



(1.2, 6.9)

< 0.020

ART-, CD4 201-499


(2.8, 8.7)

< 0.001




< 0.001

ART-, CD4 ≤ 200


(5.7, 25.7)

< 0.001



(5.6, 19.8)

< 0.001

ART+/-: on/off ART at time of RM

In the HIV+ only model, CD4≤200 vs. >200 was associated with increased risk (RR 1.5, P=0.021).  Other significant risk factors included HIV RNA level >500 copies/mL, MSM, black race, substance abuse, diabetes and lipid-lowering therapy, but not ART use or specific ART classes.

Conclusion: Risk of RM is elevated in HIV+ persons, particularly among those with advanced immunodeficiency.  These findings highlight the importance of immune preservation for preventing RM.

Subject Category: H. HIV/AIDS and other retroviruses

William Towner, MD1, Wendy A. Leyden, MPH2, Chun Chao, PhD3, Lanfang Xu, MS4, Michael Horberg, MD MAS5, Daniel Klein, MD6, Beth Tang, MA3, Leo Hurley, MPH7 and Michael J. Silverberg, PhD, MPH2, (1)Infectious Disease, Kaiser Permanente Medical Center, Los Angeles, CA, (2)Division of Research, Kaiser Permanente, Oakland, CA, (3)Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, (4)Department of Research and Evaluation, Pasadena, CA, (5)Kaiser Permanente Medical Care Program, Oakland, CA, (6)Kaiser Permanente, Hayward, CA, (7)Kaiser Permanente, Oakland, CA


W. Towner, Pfizer: Grant Investigator and Investigator, Research grant and Research support
Gilead: Investigator, Research support
Tibotec: Investigator, Research support
Merck: Grant Investigator and Investigator, Research grant and Research support

W. A. Leyden, None

C. Chao, Pfizer: Grant Investigator, Research grant
Amgen: Grant Investigator, Research grant
Merck: Grant Investigator, Research grant

L. Xu, None

M. Horberg, None

D. Klein, pfizer: Investigator, Research support
gilead: Investigator, Research support
merck: Investigator, Research support

B. Tang, None

L. Hurley, None

M. J. Silverberg, Pfizer, Inc.: Grant Investigator, Research grant

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