Lea Alexandra N, Lyass Asya, Hurley Leo B, Ehrbar Rachel Q, Mahoney Taylor F, Borowsky Leila H, He Wei, Plutzky Jorge, Triant Virginia A, Silverberg Michael J
Division of Research, Kaiser Permanente Northern California, Pleasanton, California, United States of America.
Department of Mathematics and Statistics, Boston University, Boston, Massachusetts, United States of America.
PLoS One. 2025 Jun 23;20(6):e0325773. doi: 10.1371/journal.pone.0325773. eCollection 2025.
People with HIV have a higher risk of myocardial infarction (MI) compared with people without HIV. Real world evidence on whether the increased burden of MI in people with HIV is sustained over time is essential for understanding cardiovascular disease (CVD) patterns, optimizing management, and identifying unmet needs. To help fill this gap, we completed a cohort study of people with HIV and propensity matched people without HIV in two distinct US-based integrated healthcare systems (Kaiser Permanente Northern California and Mass General Brigham). Electronic health records were assessed for association of HIV status on MI risk in two calendar eras defined by baseline year: 2005-2009 and 2010-2017, with maximum 5-year follow-up, through 2020. Cox proportional hazards models were used to obtain adjusted hazard ratios (HR) for HIV status on MI risk overall and by cohort. Adjusted models controlled for demographics and traditional CVD risk factors. We included 9,401 people with HIV (78 with MI) and 29,418 people without HIV (204 with MI). In adjusted models, the HR for MI in people with HIV was 1.10 (95% CI, 0.76, 1.60) for years 2005-2009 and 1.66 (95% CI, 1.15, 2.39) for years 2010-2017 compared with people without HIV, with a corresponding P-interaction between HIV status and calendar era of 0.12. Differences were largely due to decreases in MI risk for people without HIV. The magnitude of HRs by calendar era was consistent across models stratified by cohort. Results showed an increased MI risk persisted among people with HIV in recent years relative to people without HIV, even as CVD rates are decreasing in the general population. In light of known HIV-specific CVD risk factors, continued surveillance for MIs is merited.
与未感染艾滋病毒的人相比，感染艾滋病毒的人患心肌梗死（MI）的风险更高。关于艾滋病毒感染者心肌梗死负担增加是否会随着时间持续存在的真实世界证据，对于理解心血管疾病（CVD）模式、优化管理以及确定未满足的需求至关重要。为了填补这一空白，我们在美国两个不同的综合医疗系统（北加利福尼亚凯撒医疗集团和麻省总医院布莱根分院）中，对感染艾滋病毒的人和倾向匹配的未感染艾滋病毒的人进行了一项队列研究。通过电子健康记录评估了在以基线年份定义的两个日历时期（2005 - 2009年和2010 - 2017年）中，艾滋病毒感染状况与心肌梗死风险的关联，并进行了最长5年的随访，直至2020年。使用Cox比例风险模型来获得艾滋病毒感染状况对总体心肌梗死风险以及按队列划分的心肌梗死风险的调整后风险比（HR）。调整后的模型控制了人口统计学因素和传统的心血管疾病风险因素。我们纳入了9401名感染艾滋病毒的人（78人发生心肌梗死）和29418名未感染艾滋病毒的人（204人发生心肌梗死）。在调整后的模型中，与未感染艾滋病毒的人相比，2005 - 2009年感染艾滋病毒的人发生心肌梗死的HR为1.10（95%CI，0.76，1.60），2010 - 2017年为1.66（95%CI，1.15，2.39），艾滋病毒感染状况与日历时期之间相应的P交互作用为0.12。差异主要是由于未感染艾滋病毒的人心肌梗死风险降低。按日历时期划分的HR大小在按队列分层的模型中是一致的。结果显示，近年来与未感染艾滋病毒的人相比，感染艾滋病毒的人发生心肌梗死的风险持续增加，尽管普通人群中心血管疾病发病率正在下降。鉴于已知的艾滋病毒特异性心血管疾病风险因素，值得继续对心肌梗死进行监测。
