Shitole Sanyog G, Kuniholm Mark H, Hanna David B, Boucher Thomas, Peng Angel Y, Berardi Cecilia, Shah Tina, Bortnick Anna E, Christia Panagiota, Scheuer James, Kizer Jorge R
University of California San Francisco and San Francisco Veterans Affairs Health Care System, 4150 Clement Street, San Francisco, CA, 94121, USA.
University at Albany, 1 University Place, Rensselaer, NY, 12144, USA.
Atherosclerosis. 2020 Oct;311:60-66. doi: 10.1016/j.atherosclerosis.2020.08.005. Epub 2020 Aug 27.
HIV and HCV have been linked to an increased risk of cardiovascular disease (CVD). Their impact on long-term outcomes following ST-segment myocardial infarction (STEMI) has not been previously studied.
We leveraged data from a STEMI registry (n = 1208) at an inner-city health system to assess the influence of HIV and HCV on post-STEMI outcomes. Cox regression was used to compare HIV-monoinfected (n = 22), HCV-monoinfected (n = 26) and HIV-HCV-coinfected patients (n = 8) with the neither-infected group (n = 1152) with regard to death, death or any readmission, and death or CVD readmission.
The cohort was majority black or Hispanic. Median follow-up was 4.3 years. Compared to the neither-infected group, the HIV-monoinfected group showed near-significantly higher risks of death or any readmission (HR = 1.62, 95% CI = 0.96, 2.74) and death or CVD readmission (HR = 1.82, 95% CI = 0.98, 3.39) after full adjustment. On similar comparison, the HCV-monoinfected group exhibited significantly higher risks of death (HR = 2.09, 95% CI = 1.05, 4.15) and death or any readmission (HR = 1.68, 95% CI = 1.07, 2.65), whereas the HIV-HCV-coinfected group showed higher risk of death (HR = 6.51, 95% CI = 2.28, 18.61).
In this cohort composed mostly of race-ethnic minorities, HIV monoinfection tended to be associated with 1.6-to-1.8-fold higher risk of death or readmission for any cause or CVD over long-term follow-up compared to neither infection, whereas HCV monoinfection was associated with 1.7-to-2.1-fold higher risk of death and death or any readmission, and HIV-HCV coinfection with 6.5-fold higher risk of death. These associations require further study in larger populations, but highlight the importance of identifying and treating HIV and HCV in patients presenting with STEMI.
HIV和HCV与心血管疾病（CVD）风险增加有关。此前尚未研究它们对ST段抬高型心肌梗死（STEMI）后长期预后的影响。
我们利用一个市中心医疗系统的STEMI登记处的数据（n = 1208）来评估HIV和HCV对STEMI后预后的影响。采用Cox回归比较单纯HIV感染组（n = 22）、单纯HCV感染组（n = 26）和HIV-HCV合并感染组（n = 8）与未感染组（n = 1152）在死亡、死亡或任何再入院以及死亡或CVD再入院方面的情况。
该队列中大多数为黑人或西班牙裔。中位随访时间为4.3年。与未感染组相比，在完全调整后，单纯HIV感染组出现死亡或任何再入院（HR = 1.62，95%CI = 0.96，2.74）以及死亡或CVD再入院（HR = 1.82，95%CI = 0.98，3.39）的风险接近显著升高。在类似比较中，单纯HCV感染组出现死亡（HR = 2.09，95%CI = 1.05，4.15）以及死亡或任何再入院（HR = 1.68，95%CI = 1.07，2.65）的风险显著升高，而HIV-HCV合并感染组出现死亡的风险更高（HR = 6.51，95%CI = 2.28，18.61）。
在这个主要由少数族裔组成的队列中，与未感染相比，在长期随访中，单纯HIV感染往往与因任何原因或CVD导致的死亡或再入院风险高1.6至1.8倍相关，而单纯HCV感染与死亡以及死亡或任何再入院风险高1.7至2.1倍相关，HIV-HCV合并感染与死亡风险高6.5倍相关。这些关联需要在更大规模人群中进一步研究，但突出了在STEMI患者中识别和治疗HIV及HCV的重要性。
