Patients with HIV have poor clinical outcomes after acute coronary syndrome

Patients with HIV infection are more likely to experience poor clinical outcomes after acute coronary syndrome (ACS) or percutaneous coronary interventions (PCIs), according to study results published in JAMA Network Open.

Researchers conducted a systematic review and meta-analysis of longitudinal studies to better characterize clinical outcomes among patients with HIV infection after ACS or PCIs. Publication databases were searched through August 2023 for studies involving patients with HIV and an HIV-negative comparator group, patients presenting with ACS or undergoing PCI, and longitudinal follow-up data after the index event. The primary outcomes included all-cause mortality, major adverse cardiovascular events, cardiovascular death, recurrent ACS, stroke, new heart failure, total lesion revascularization, and total vessel revascularization. A random-effects model was used to pool clinical outcome data for the meta-analysis.

Fifteen studies (retrospective design, n=12; prospective design, n=3) were identified for the analysis, comprising 9499 HIV-positive patients (mean age, 56.2 years; men, 76.4%; White, 13.1%) and 1,531,117 HIV-negative patients (mean age, 67.7 years; men, 61.7%; White, 21.1%).

Compared with HIV-negative patients, those with HIV were significantly more likely to be active smokers (P <.001), report illicit drug use (P <.001), have higher triglyceride levels (P =.01), and have lower high-density lipoprotein cholesterol levels (P =.03).

Pooled data captured from patients with and without HIV infection after AVS or revascularization showed mean follow-up durations of 16.2 and 11.9 months, respectively. Further analysis between the groups indicated HIV-positive patients were at increased risk for the following outcomes:

• All-cause mortality (adjusted relative risk [aRR], 1.64; 95% CI, 1.32-2.04);
• Major adverse cardiovascular events (aRR, 1.11; 95% CI, 1.01-1.22);
• Recurrent ACS (aRR, 1.83; 95% CI, 1.12-2.97);
• Readmission for heart failure (aRR, 3.39; 95% CI, 1.73-6.62); and
• Restenosis (aRR, 2.40; 95% CI, 1.13-5.09).

There were no between-group differences observed in the risk for cardiovascular death, total vessel revascularization, and total lesion revascularization.

Limitations of this study include potentially reduced generalizability as patients predominantly resided in high-income countries, the lack of data on the duration of or adherence to antiretroviral therapy and cardioprotective medications, and the inability to assess the association between HIV status and cardiovascular disease outcomes among subgroups.

“These findings suggest the need for attention toward secondary prevention strategies to address poor outcomes of cardiovascular disease among patients living with HIV,” the researchers concluded.

Disclosures: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

By Jessica Nye, PhD

References:

Haji M, Capilupi M, Kwok M, et al. Clinical outcomes after acute coronary syndromes or revascularization among people living with HIV: a systematic review and meta-analysis. JAMA Netw Open. 2024;7(5):e2411159. doi:10.1001/jamanetworkopen.2024.11159