University Department of Medicine and Infectious Diseases Service, Kantonsspital Baselland, University of Basel, Bruderholz, Switzerland.
Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
Clin Infect Dis. 2023 Jun 8;76(11):1969-1979. doi: 10.1093/cid/ciad033.
People with human immunodeficiency virus (HIV; PWH) have increased cardiovascular risk. Higher leukocyte count has been associated with coronary artery disease (CAD) events in the general population. It is unknown whether the leukocyte-CAD association also applies to PWH.
In a case-control study nested within the Swiss HIV Cohort Study, we obtained uni- and multivariable odds ratios (OR) for CAD events, based on traditional and HIV-related CAD risk factors, leukocyte count, and confounders previously associated with leukocyte count.
We included 536 cases with a first CAD event (2000-2021; median age, 56 years; 87% male; 84% with suppressed HIV RNA) and 1464 event-free controls. Cases had higher latest leukocyte count before CAD event than controls (median [interquartile range], 6495 [5300-7995] vs 5900 [4910-7200]; P < .01), but leukocytosis (>11 000/µL) was uncommon (4.3% vs 2.1%; P = .01). In the highest versus lowest leukocyte quintile at latest time point before CAD event, participants had univariable CAD-OR = 2.27 (95% confidence interval, 1.63-3.15) and multivariable adjusted CAD-OR = 1.59 (1.09-2.30). For comparison, univariable CAD-OR for dyslipidemia, diabetes, and recent abacavir exposure were 1.58 (1.29-1.93), 2.19 (1.59-3.03), and 1.73 (1.37-2.17), respectively. Smoking and, to a lesser degree, alcohol and ethnicity attenuated the leukocyte-CAD association. Leukocytes measured up to 8 years before the event were significantly associated with CAD events.
PWH in Switzerland with higher leukocyte counts have an independently increased risk of CAD events, to a degree similar to traditional and HIV-related risk factors.
人类免疫缺陷病毒（HIV；HIV 感染者）的心血管风险增加。白细胞计数升高与普通人群的冠状动脉疾病（CAD）事件相关。尚不清楚白细胞与 CAD 的关联是否也适用于 HIV 感染者。
在瑞士 HIV 队列研究中嵌套的病例对照研究中，我们基于传统和与 HIV 相关的 CAD 危险因素、白细胞计数以及先前与白细胞计数相关的混杂因素，获得了 CAD 事件的单变量和多变量比值比（OR）。
我们纳入了 536 例首次 CAD 事件（2000-2021 年；中位年龄 56 岁；87%为男性；84%的 HIV RNA 得到抑制）和 1464 例无事件对照。与对照组相比，病例在 CAD 事件前的最新白细胞计数更高（中位数[四分位数间距]，6495[5300-7995]与 5900[4910-7200]；P<.01），但白细胞增多（>11000/µL）并不常见（4.3%与 2.1%；P=.01）。在 CAD 事件前最新时间点的白细胞最高五分位与最低五分位相比，患者的单变量 CAD-OR 为 2.27（95%置信区间，1.63-3.15），多变量校正 CAD-OR 为 1.59（1.09-2.30）。相比之下，血脂异常、糖尿病和最近使用阿巴卡韦的单变量 CAD-OR 分别为 1.58（1.29-1.93）、2.19（1.59-3.03）和 1.73（1.37-2.17）。吸烟以及在较小程度上的饮酒和种族，削弱了白细胞与 CAD 的关联。在事件发生前长达 8 年测量的白细胞与 CAD 事件显著相关。
瑞士的 HIV 感染者白细胞计数较高，其 CAD 事件的风险独立增加，其程度与传统和与 HIV 相关的危险因素相似。
