Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN (J.A.B., M.S.D., M.S.F.).
Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, PA (C.W.A.).
Circulation. 2018 Jul 17;138(3):255-265. doi: 10.1161/CIRCULATIONAHA.117.032647. Epub 2018 Mar 13.
The effect of human immunodeficiency virus (HIV) on the development of peripheral artery disease (PAD) remains unclear. We investigated whether HIV infection is associated with an increased risk of PAD after adjustment for traditional atherosclerotic risk factors in a large cohort of HIV-infected (HIV+) and demographically similar HIV-uninfected veterans.
We studied participants in the Veterans Aging Cohort Study from April 1, 2003 through December 31, 2014. We excluded participants with known prior PAD or prevalent cardiovascular disease (myocardial infarction, stroke, coronary heart disease, and congestive heart failure) and analyzed the effect of HIV status on the risk of incident PAD events after adjusting for demographics, PAD risk factors, substance use, CD4 cell count, HIV-1 ribonucleic acid, and antiretroviral therapy. The primary outcome is incident peripheral artery disease events. Secondary outcomes include mortality and amputation in subjects with incident PAD events by HIV infection status, viral load, and CD4 count.
Among 91 953 participants, over a median follow up of 9.0 years, there were 7708 incident PAD events. Rates of incident PAD events per 1000 person-years were higher among HIV+ (11.9; 95% confidence interval [CI], 11.5-12.4) than uninfected veterans (9.9; 95% CI, 9.6-10.1). After adjustment for demographics, PAD risk factors, and other covariates, HIV+ veterans had an increased risk of incident PAD events compared with uninfected veterans (hazard ratio [HR], 1.19; 95% CI, 1.13-1.25). This risk was highest among those with time-updated HIV viral load >500 copies/mL (HR, 1.51; 95% CI, 1.38-1.65) and CD4 cell counts <200 cells/mm (HR, 1.91; 95% CI, 1.71-2.13). In contrast, HIV+ veterans with time updated CD4 cell count ≥500 cells/mm had no increased risk of PAD (HR, 1.03; 95% CI, 0.96-1.11). Mortality rates after incident PAD events are high regardless of HIV status. HIV infection did not affect rates of amputation after incident PAD events.
Infection with HIV is associated with a 19% increased risk of PAD beyond that explained by traditional atherosclerotic risk factors. However, for those with sustained CD4 cell counts <200 cells/mm, the risk of incident PAD events is nearly 2-fold higher whereas for those with sustained CD4 cell counts ≥500 cells/mm there is no excess risk of incident PAD events compared with uninfected people.
人类免疫缺陷病毒（HIV）对周围动脉疾病（PAD）发展的影响仍不清楚。我们研究了在一个大型 HIV 感染（HIV+）和人口统计学相似的 HIV 未感染退伍军人队列中，是否在调整传统动脉粥样硬化危险因素后，HIV 感染与 PAD 风险增加相关。
我们研究了 2003 年 4 月 1 日至 2014 年 12 月 31 日期间 Veterans Aging Cohort Study 的参与者。我们排除了已知有既往 PAD 或现患心血管疾病（心肌梗死、中风、冠心病和充血性心力衰竭）的参与者，并在调整人口统计学、PAD 危险因素、物质使用、CD4 细胞计数、HIV-1 核糖核酸和抗逆转录病毒治疗后，分析了 HIV 状况对 PAD 事件发生风险的影响。主要结局是 PAD 事件的发生。次要结局包括按 HIV 感染状况、病毒载量和 CD4 计数，分析发生 PAD 事件患者的死亡率和截肢率。
在 91953 名参与者中，中位随访时间为 9.0 年，发生了 7708 例 PAD 事件。HIV+（11.9；95%置信区间[CI]，11.5-12.4）患者的 PAD 事件发生率高于未感染退伍军人（9.9；95%CI，9.6-10.1）。在调整人口统计学、PAD 危险因素和其他混杂因素后，与未感染的退伍军人相比，HIV+退伍军人发生 PAD 事件的风险增加（风险比[HR]，1.19；95%CI，1.13-1.25）。在那些 HIV 病毒载量>500 拷贝/ml（HR，1.51；95%CI，1.38-1.65）和 CD4 细胞计数<200 个/mm（HR，1.91；95%CI，1.71-2.13）的患者中，这种风险最高。相比之下，HIV+退伍军人中 CD4 细胞计数更新时间≥500 个/mm 的患者发生 PAD 的风险没有增加（HR，1.03；95%CI，0.96-1.11）。无论 HIV 状态如何，PAD 事件后死亡率都很高。HIV 感染并不影响 PAD 事件后截肢率。
除了传统动脉粥样硬化危险因素之外，HIV 感染与 PAD 风险增加 19%相关。然而，对于那些持续 CD4 细胞计数<200 个/mm 的患者，发生 PAD 事件的风险几乎增加了 2 倍，而对于那些持续 CD4 细胞计数≥500 个/mm 的患者，与未感染的人相比，发生 PAD 事件的风险没有增加。
