舊金山——抗微生物製劑和化療跨學科年會上公布的一項對全美住院患者樣本數據庫的二次分析顯示，合並急性心肌梗死(MI)的HIV陽性住院患者的死亡風險較陰性者高53%。HIV陽性和陰性患者的院內急性MI死亡率分別為4.3%和2.4%，差異顯著。

　　Daniel Pearce博士

　　在這項研究中，加州河濱縣公共衛生部的Daniel Pearce博士及其同事分析了1997~2006年全美所有非聯邦、短期、綜合和成人專科醫院收治的約150萬例(接近20%的分層樣本)住院1天以上的急性MI成人患者。

　　校正年齡、種族、性別、合並症和保險類型(社會經濟地位指標)的效應後發現，5984例HIV陽性患者的MI死亡風險(HR)比HIV陰性患者高53%。

　　與HIV陰性患者相比，HIV陽性患者明顯更年輕(平均64歲 vs. 54歲)，男性比例更高(65% vs. 72%)，而且參加醫療保險的比例更高(62% vs. 25%)。

　　HIV陽性患者的合並症負擔大於HIV陰性患者，兩組的平均Charlson合並症指數評分分別為1.14和0.94。HIV陽性患者中發生率顯著高於HIV陰性患者的合並症包括腎病(13% vs. 5%)、 輕度肝病(8% vs. 1%)和心力衰竭(26% vs. 20%)。HIV陽性患者中合並高血壓、糖尿病和心律失常等最常見心髒代謝危險因素的比例低於HIV陰性患者。HIV陽性患者中濫用物質的比例高於HIV陰性患者。

　　Pearce博士推測，HIV陽性患者較高的死亡率可能與HIV病毒血症對心髒血管、功能的病理影響有關。

　　相關評論：死亡風險增加的原因不明

　　Howard Edelstein博士

　　加州奧克蘭阿拉米達縣醫學中心的傳染病專家Howard Edelstein博士表示，HIV感染者的院內MI死亡率較高除了可能與HIV感染有關之外，還可歸因於其他因素，如生活方式、使用毒品、治療不連續、無法獲得醫療服務等。

　　Pearce 博士和Edelstein博士均聲明無經濟利益衝突。

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.