Department of Medicine Section of Pulmonary Diseases, Critical Care, and Environmental Medicine Tulane University School of Medicine New Orleans LA.
Department of Medicine Division of Cardiovascular Medicine Vanderbilt University Medical Center Nashville TN.
J Am Heart Assoc. 2020 Dec;9(23):e017645. doi: 10.1161/JAHA.120.017645. Epub 2020 Nov 23.
Background Hospitalization with community-acquired pneumonia (CAP) is associated with an increased risk of cardiovascular disease (CVD) events in patients uninfected with HIV. We evaluated whether people living with HIV (PLWH) have a higher risk of CVD or mortality than individuals uninfected with HIV following hospitalization with CAP. Methods and Results We analyzed data from the Veterans Aging Cohort Study on US veterans admitted with their first episode of CAP from April 2003 through December 2014. We used Cox regression analyses to determine whether HIV status was associated with incident CVD events and mortality from date of admission through 30 days after discharge (30-day mortality), adjusting for known CVD risk factors. We included 4384 patients (67% [n=2951] PLWH). PLWH admitted with CAP were younger, had less severe CAP, and had fewer CVD risk factors than patients with CAP who were uninfected with HIV. In multivariable-adjusted analyses, CVD risk was similar in PLWH compared with HIV-uninfected (hazard ratio [HR], 0.89; 95% CI, 0.70-1.12), but HIV infection was associated with higher mortality risk (HR, 1.49; 95% CI, 1.16-1.90). In models stratified by HIV status, CAP severity was significantly associated with incident CVD and 30-day mortality in PLWH and patients uninfected with HIV. Conclusions In this study, the risk of CVD events during or after hospitalization for CAP was similar in PLWH and patients uninfected with HIV, after adjusting for known CVD risk factors and CAP severity. HIV infection, however, was associated with increased 30-day mortality after CAP hospitalization in multivariable-adjusted models. PLWH should be included in future studies evaluating mechanisms and prevention of CVD events after CAP.
与未感染 HIV 的患者相比，社区获得性肺炎（CAP）住院与心血管疾病（CVD）事件风险增加相关。我们评估了 HIV 感染者（PLWH）在因 CAP 住院后，其 CVD 风险或死亡率是否高于未感染 HIV 的个体。
我们分析了美国退伍军人老龄化队列研究中 2003 年 4 月至 2014 年 12 月期间首次因 CAP 入院的退伍军人的数据。我们使用 Cox 回归分析来确定 HIV 状况是否与入院后至出院后 30 天（30 天死亡率）的 CVD 事件和死亡率相关，调整了已知的 CVD 风险因素。我们纳入了 4384 例患者（67%[n=2951]PLWH）。与未感染 HIV 的 CAP 患者相比，PLWH 因 CAP 入院时更年轻、CAP 病情较轻、且 CVD 风险因素较少。在多变量调整分析中，PLWH 的 CVD 风险与 HIV 未感染者相似（风险比 [HR]，0.89；95%CI，0.70-1.12），但 HIV 感染与更高的死亡率风险相关（HR，1.49；95%CI，1.16-1.90）。在按 HIV 状态分层的模型中，CAP 严重程度与 PLWH 和未感染 HIV 的患者发生 CVD 事件和 30 天死亡率均显著相关。
在本研究中，在调整已知的 CVD 风险因素和 CAP 严重程度后，PLWH 和未感染 HIV 的 CAP 住院患者在 CAP 住院期间或之后发生 CVD 事件的风险相似。然而，在多变量调整模型中，HIV 感染与 CAP 住院后 30 天死亡率增加相关。在评估 CAP 后 CVD 事件的机制和预防措施的未来研究中，应包括 PLWH。
