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Atrial Fibrillation at an Earlier Age in People With HIV Infection
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9th IAS Conference on HIV Science (IAS 2017), July 23-26, 2017, Paris
"AF occurred at a median age of 61 years in PLHIV vs 75 years (p-value <0.001) in the HIV-negative individuals.....Among people younger than 50, incidence was higher with than without HIV (0.98% versus 0.45%), and the HIV group had more than a doubled incidence (rate ratio 2.20, 95% CI 1.68 to 2.89)."
Mark Mascolini
People with HIV had atrial fibrillation at an earlier age than people without HIV in a population-based comparison in British Columbia, Canada [1]. In the HIV group, atrial fibrillation proved more frequent in people with a lower CD4 count and an AIDS diagnosis, while longer antiretroviral therapy favored lower incidence.
HIV-positive people run a higher risk of myocardial infarction [2] and other cardiovascular diseases [2] than the general population. Atrial fibrillation ranks as the most common arrhythmia, but little is known about its incidence and risk factors in people with HIV. To address those question, researchers in British Columbia conducted this study.
The investigators created a population-based data set by linking data from the BC Centre for Excellence in HIV/AIDS and Population Data BC. They compared HIV-positive people at least 19 years old with a random 10% sample of HIV-negative people in British Columbia. Then they used ICD-9 and 10 codes to identify atrial fibrillation diagnoses from 1996 to 2013. The researchers calculated age-adjusted incidence by using the age distribution in the 2011 Canadian standard population. They used generalized estimating equation models to explore associations between atrial fibrillation incidence and demographic and clinical variables.
The analysis included 13,907 people with HIV and 514,952 HIV-negative people. Atrial fibrillation developed in 265 HIV-positive people (1.9%) and 20,244 people without HIV (3.9%). Median age at diagnosis was 61 in the HIV group (interquartile range [IQR] 52 to 70) and 75 in the HIV-negative group (IQR 66 to 82).
Age-standardized atrial fibrillation incidence was 2.40 (95% confidence interval [CI] 2.01 to 2.78) per 1000 person-years in the HIV group and 2.75 per 1000 person-years (95% CI 2.71 to 2.79) in the HIV-negative group. The rate ratio comparing people with versus without HIV was 0.87 (95% CI 0.73 to 1.01). Among people younger than 50, incidence was higher with than without HIV (0.98% versus 0.45%), and the HIV group had more than a doubled incidence (rate ratio 2.20, 95% CI 1.68 to 2.89).
The adjusted GEE model identified four independent predictors of atrial fibrillation in people with HIV, at the following rate ratios (RR) (and 95% CI):
-- Older age: RR 2.13 (1.91 to 2.38) for every 10 years older
-- Male sex: RR 1.58 (1.04 to 2.09)
-- Lower baseline CD4 count: RR 0.56 (0.33 to 0.93) for 350-499 vs <200; RR 0.36 (0.21 to 0.62) for 500+ vs <200
-- AIDS-defining illness at baseline: RR 1.84 (1.15 to 2.95)
Longer time taking antiretrovirals was associated with lower atrial fibrillation incidence (RR 0.82, 95% CI 0.79 to 0.86).
References
1. Vizcarra P, Eyawo O, Ye M, et al. Incidence and factors associated with atrial fibrillation in people with human immunodeficiency virus in British Columbia, Canada. 9th IAS Conference on HIV Science (IAS 2017), July 23-26, 2017, Paris. Abstract WEPEB0504.
2. Freiberg MS, Chang CC, Kuller LH, et al. HIV infection and the risk of acute myocardial infarction. JAMA Intern Med. 2013;173:614-622.
3. Chow FC, Regan S, Feske S, Meigs JB, Grinspoon SK, Triant VA. Comparison of ischemic stroke incidence in HIV-infected and non-HIV-infected patients in a US health care system. J Acquir Immune Defic Syndr. 2012;60:351-358.
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Incidence And Factors Associated With Atrial Fibrillation In People Living With Human Immunodeficiency Virus In British Columbia, Canada
P. Vizcarra1-2, O. Eyawo1, M. Ye1, M. Lu1, M. Bennett3, R. Hogg1, J. Montaner1, S. Guillemi1
1BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia Canada;2 "Gral. San Martin" Hospital, La Plata, Buenos Aires, Argentina; 3Vancouver Coastal Health, Vancouver, British Columbia, Canada;
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