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History of AIDS in HIV-Infected Patients Is Associated With Higher In-Hospital Mortality Following Admission for Acute Myocardial Infarction and Stroke
 
 
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JID June 15 2016
 
from Jules: this study looked at patients with a history of AIDS which includes HIV+ who started ART with a low nadir CD4 such as in the earlier days until patients were recommended to start ART when CD4s hit 350. In the early days of ART from around 1996 when PIs were first approved there were battles about starting ART before or after CD4s declined to low levels like 200 or 300 even; one could make an argument that delaying HAART until CD4s bottomed out was a mistake. It appears not just with CVD but all comorbidities that the depleted immune system that resulted by delaying ART until CD4s are so low played an important role in increasing the risk now for aging patients to develop comorbidities & accelerated aging, contributing to accelerated & increased risk for frailty, cognitive impairment perhaps, etc. Other studies have found immunosuppression in general, lower CD4 is associated with higher risk for comorbidities. ....."Exposure to HIV-induced immunosuppression has been linked to an increased risk of many non-AIDS-related conditions......Our study increases the understanding of non-AIDS-related clinical consequences of chronic HIV infection"........SO clearly it is important to keep CD4s high and to improve immunity as best as possible which means the best diet & exercise regimen possible!
 
"The current study examined the in-hospital outcomes of AMI and stroke in patients with a history of AIDS, HIV-infected patients without a history of AIDS, and uninfected patients. To accomplish this goal, we used the Nationwide Inpatient Sample (NIS), a registry of billing data for >87 million all-payer hospitalizations in the United States."
 
"Patients with a history of AIDS were significantly more likely than uninfected patients to die during hospitalization after admission for AMI or stroke. This disparity was not observed when infected patients without a history of AIDS were compared to uninfected patients, implying that preserving immune function may improve cardiovascular outcomes in HIV-infected persons."
 
"This study documents an association between a history of HIV-induced immunosuppression and outcomes of major CVD events. Patients with a history of AIDS who were hospitalized for either AMI or stroke had a significantly higher risk of in-hospital mortality, a significantly higher likelihood of discharge to nonhospital inpatient facilities, and a significantly longer length of stay than uninfected patients. By contrast, the outcomes of HIV-infected patients without a history of AIDS were similar to those of uninfected patients. This observation is important because CVD is now one of the leading causes of death among patients with chronic HIV infection and because antiretroviral therapy can dramatically improve HIV-induced immunosuppression [7]. These findings are also timely given the results of the recently published Strategic Timing of Antiretroviral Therapy trial, which indicate that even mild levels of HIV-induced immunosuppression (eg, a CD4+ T-cell count of 350 cells/mm3) adversely affects risk for non-AIDS-related outcomes [8]."
 
"Our study increases the understanding of non-AIDS-related clinical consequences of chronic HIV infection. We found that HIV-infected patients who developed AMI or stroke were more than twice as likely to die during hospitalization as uninfected patients with the same CVD event and that most of this mortality risk was borne by patients with a history of AIDS. Clarifying the disproportionate distribution of CVD-associated risk among HIV-infected patients is important because of the growing overlap between the 2 epidemics. Given that over half of HIV-infected patients living in the United States will be aged ≥50 years by 2017 [9], the number of HIV-infected patients with CVD will continue to climb. The precipitous increase in the number of hospitalizations for AMI and stroke among HIV-infected patients over the study period (Figure 1) are a likely manifestation of the rapid aging of this population [10]. Thus, there is an urgent need to improve our understanding of CVD in this population."
 
"Exposure to HIV-induced immunosuppression has been linked to an increased risk of many non-AIDS-related conditions [11-14]. Nadir CD4+ T-cell counts of <350 cells/mm3 are associated with surrogates of atherosclerosis [15, 16], including increased carotid intima-media thickness and decreased arterial compliance (indicated by flow-mediated dilatation). Low nadir CD4+ T-cell counts have also been associated with increased levels of the inflammatory marker interleukin 6 [17], sustained hypertension, and left ventricular hypertrophy [18, 19]. These findings of adverse vascular physiology associated with severe HIV-induced immunosuppression appear to corroborate with published clinical experience. For example, 2 large studies of the Northern California Kaiser Permanente cohort showed that HIV-infected patients with a CD4+ T-cell count of ≤200 cells/mm3 had a 74% higher incidence of AMI and a 60% higher incidence of stroke than uninfected patients. Interestingly, there was no significant difference between the incidence rate of AMI and stroke in HIV-infected cohort members with nadir CD4+ T-cell counts of ≥500 cells/mm3 and uninfected patients [3, 20]. The current study provides a key finding by linking the prognosis of HIV-infected patients with AMI or stroke to the patient's level of HIV-associated immunosuppression."
 
"Cardiovascular disease (CVD) is now one of the leading causes of death in human immunodeficiency virus (HIV)-infected patients in the United States [1-4]. HIV-infected patients are at higher risk for acute myocardial infarction (AMI) than uninfected patients, even after adjustment for traditional CVD risk factors [2-4]. This increased risk of CVD may be linked to the severity of HIV-associated immunosuppression. For example, a recent study found no significant difference in the incidence of AMI among uninfected patients and patients with less advanced HIV infection [3]. By contrast, little is known about the relationship between severity of HIV infection and clinical outcomes in patients with AMI or stroke. The current study examined the in-hospital outcomes of AMI and stroke in patients with a history of AIDS, HIV-infected patients without a history of AIDS, and uninfected patients. To accomplish this goal, we used the Nationwide Inpatient Sample (NIS), a registry of billing data for >87 million all-payer hospitalizations in the United States."
 
Abstract
 
Background
. Although human immunodeficiency virus (HIV)-infected persons are at increased risk for major cardiovascular events, short-term prognosis after these events is unclear.
 
Methods. To determine the association between HIV infection and acute myocardial infarction (AMI) and stroke outcomes, we analyzed hospital discharge data from the Nationwide Inpatient Sample (NIS) between 2002 and 2012. Multivariable logistic regression was used to evaluate the association between HIV infection and in-hospital death after AMI or stroke.
 
Results. Overall, 18 369 785 AMI/stroke hospitalizations were included in the analysis. Patients with a history of AIDS were significantly more likely than uninfected patients to die during hospitalization after admission for AMI or stroke (odds ratio, 3.03 [95% confidence interval {CI}, 1.71-5.38] for AMI and 2.59 [95% CI, 1.97-3.41] for stroke). Additionally, patients with AIDS were more likely than HIV-uninfected patients to be discharged to nonhospital inpatient facilities after admission for AMI (OR, 3.14 [95% CI, 1.72-5.74]) or stroke (OR, 1.45; 95% CI, 1.12-1.87). There was a minimal difference in either outcome between HIV-infected patients without a history of AIDS and uninfected patients.
 
Conclusions. Patients with a history of AIDS were significantly more likely than uninfected patients to die during hospitalization after admission for AMI or stroke. This disparity was not observed when infected patients without a history of AIDS were compared to uninfected patients, implying that preserving immune function may improve cardiovascular outcomes in HIV-infected persons.

 
 
 
 
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