HIV阳性住院患者心梗死亡率增加五成

旧金山——抗微生物制剂和化疗跨学科年会上公布的一项对全美住院患者样本数据库的二次分析显示，合并急性心肌梗死(MI)的HIV阳性住院患者的死亡风险较阴性者高53%。HIV阳性和阴性患者的院内急性MI死亡率分别为4.3%和2.4%，差异显著。

Daniel Pearce博士

在这项研究中，加州河滨县公共卫生部的Daniel Pearce博士及其同事分析了1997~2006年全美所有非联邦、短期、综合和成人专科医院收治的约150万例(接近20%的分层样本)住院1天以上的急性MI成人患者。

校正年龄、种族、性别、合并症和保险类型(社会经济地位指标)的效应后发现，5984例HIV阳性患者的MI死亡风险(HR)比HIV阴性患者高53%。

与HIV阴性患者相比，HIV阳性患者明显更年轻(平均64岁 vs. 54岁)，男性比例更高(65% vs. 72%)，而且参加医疗保险的比例更高(62% vs. 25%)。

HIV阳性患者的合并症负担大于HIV阴性患者，两组的平均Charlson合并症指数评分分别为1.14和0.94。HIV阳性患者中发生率显著高于HIV阴性患者的合并症包括肾病(13% vs. 5%)、 轻度肝病(8% vs. 1%)和心力衰竭(26% vs. 20%)。HIV阳性患者中合并高血压、糖尿病和心律失常等最常见心脏代谢危险因素的比例低于HIV阴性患者。HIV阳性患者中滥用物质的比例高于HIV阴性患者。

Pearce博士推测，HIV阳性患者较高的死亡率可能与HIV病毒血症对心脏血管、功能的病理影响有关。

相关评论：死亡风险增加的原因不明

Howard Edelstein博士

加州奥克兰阿拉米达县医学中心的传染病专家Howard Edelstein博士表示，HIV感染者的院内MI死亡率较高除了可能与HIV感染有关之外，还可归因于其他因素，如生活方式、使用毒品、治疗不连续、无法获得医疗服务等。

Pearce 博士和Edelstein博士均声明无经济利益冲突。

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By: SHERRY BOSCHERT, Cardiology News Digital Network

SAN FRANCISCO – Hospitalized patients who have an acute MI are 53% more likely to die if they are infected with HIV, based on a secondary analysis of data from the Nationwide Inpatient Sample database.

The mortality rates for in-hospital acute MI were 4.3% for HIV-positive patients and 2.4% for HIV-negative ones, a statistically significant difference.

HIV-positive patients had a greater burden of comorbidities, as evidenced by a mean Charlson’s Comorbidity Index score of 1.14, as compared with HIV-negative patients with an average score of 0.94. Comorbidities that were significantly more prevalent in the HIV-positive cases, compared with HIV-negative cases, included renal disease (13% vs. 5%, respectively), mild liver disease (8% vs. 1%), and heart failure (26% vs. 20%), Dr. Daniel Pearce reported at the meeting, sponsored by the American Society for Microbiology.

He and his associates analyzed data from 1997 to 2006 for nearly 1.5 million adults who were hospitalized for more than a day and had an acute MI. The data approximated a stratified 20% sample of all nonfederal, short-term, general, and specialty hospitals serving adults in the United States.

The hazard ratio for death after MI was 53% higher among the 5,984 HIV-positive patients, compared with those without HIV after adjusting for the effects of age, race, gender, comorbidity, and type of insurance (as a marker for socioeconomic status), Dr. Pearce, of the Riverside County (Calif.) Department of Public Health, and his associates reported in a poster presentation at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

The HIV-positive group was significantly younger compared with the HIV-negative group (mean ages of 54 and 64 years, respectively), more likely to be male (65% vs. 72%), and more likely to be insured primarily by Medicare or Medicaid (62% vs. 25%).

On the other hand, the HIV-positive cases had lower rates of the most common cardiometabolic risk factors, including hypertension, diabetes, and cardiac arrhythmias. Substance abuse was more prevalent in the HIV-positive group than the HIV-negative group.

Dr. Pearce speculated the higher death rate could be related to the pathological effects of HIV viremia on cardiac vasculature and function.

Dr. Pearce reported having no financial disclosures.

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Reasons for Increased Risk Are Unclear
 
The higher rate of in-hospital MI mortality in HIV-infected patients may be due to risk factors other than HIV infection itself. Many of these patients use illicit drugs and they’re in and out of care, disenfranchised, or don’t have access to medical care. We know that people with very limited resources don’t do as well with any diagnosed illness.

There may or may not be some truth to an underlying role of inflammation related to HIV infection in driving the higher rate of death, but we haven’t really locked that down yet, especially for early infection.

I’m not sure that these results show that HIV infection is the cause of the increased risk for fatal in-hospital acute MI. The risk may be related to HIV, but it may also be related to lifestyles and other risk factors.

Dr. Howard Edelstein is an infectious diseases specialist at Alameda County Medical Center, Oakland, Calif. He reported having no financial disclosures.