What is Causing an Increased Risk of Myocardial Infarction in the HIV Population?

Within the HIV population, there are factors that can increase their risk for cardiovascular disease or acute episodes. Many within this patient population are getting older, and with that comes the normal health risks people see as they age. In addition, newer ART such as integrase inhibitors can lead to weight gain and tenofovir alafenamide can lead to elevated lipids.

With these potential health risks, clinicians need to monitor patients continuously.

Michael Silverberg, PhD, MPH, research scientist and HIV epidemiologist Kaiser Permanente Northern California and a team of investigators looked at myocardial infarction (MI) risks by HIV status. Silverberg and his fellow investigators wrote an abstract on the subject, Myocardial Infarction Risk by HIV Status in 2 US Healthcare Systems, based on their research which was presented virtually at the 2022 Annual Conference on Retroviruses and Opportunistic Infection (CROI).

In their observational study, they looked at 2 time periods (2005-2009) and (2010-2017) and they included both people with HIV (PWH) and people without HIV (PWoH). They included (PWH) from Massachusetts General Hospital (Partners) and Kaiser Permanente Northern California (KPNC), identified from 2005-2017 with follow-up through 2020. Subjects also included a 1:4 propensity-matched comparison group of people without HIV (PWoH) in Partners and a 1:2 matched group in KPNC.

“Propensity scores were informed by baseline demographics (age, race, sex, year) and baseline Framingham risk score components (total cholesterol, HDL, diabetes, systolic BP, hypertension treatment and smoking status)," the investigators wrote. “We assessed effect of HIV status on MI risk in two calendar eras defined by baseline year: 2005-2009 and 2010-2017. To ensure similar follow-up of events by era, we censored follow-up at the earliest of: 5 years after baseline, death, loss-to-follow-up, or administrative end of follow-up.”

“In an earlier time period from 2005-2009, we saw a very similar rate of MI risk across these two settings,” Silverberg said. “But when you look at a more recent time period, you see that the curves diverge. There is about a 60% higher risk of a heart attack we saw in the more recent time period….In the more recent period we did see HIV patients are using more of these integrase inhibitors and that's where we saw the higher risk, so it’s possible that’s why it is contributing to the findings here and that why it is important to look at trends because things are constantly changing.”

Contagion spoke to Silverberg about the findings from the study, how they collected the data, and the importance of keeping up with health care trends including understanding the potential consequences of the newer ART that are being prescribed.