Factors Associated with Excess Myocardial Infarction Risk in HIV-infected Adults: a Systematic Review and Meta-Analysis

Understanding AMI risk and associated risk factors in HIV-infected populations has the potential to inform clinical management and prevention strategies. The study objective was to estimate the pooled relative risk of incident acute myocardial infraction (AMI) among HIV-infected adults compared to HIV-uninfected controls and explore the contribution of traditional and HIV-related risk factors.

We systematically identified cohort studies of HIV-infected or HIV-infected and matched uninfected adults reporting AMI incidence rates published up to January 1, 2017. Random-effects meta-analysis models were used to estimate the aggregate relative risk of AMI by HIV status. Subgroup analysis and meta-regression were used to explore factors affecting risk.

16 studies (N=1,619,690, median age 38.5 years, 78.9% male, mean follow-up of 6.5 years) were included. In pooled analyses of HIV-infected and matched uninfected cohorts (n=5), HIV-infected individuals had higher AMI incidence rates (absolute risk difference=2.2 cases per 1000 persons per year) and twice the risk of AMI (RR=1.96 [1.5, 2.6]) compared with matched HIV-uninfected controls. In a multivariate meta-regression, each additional percentage point in the proportion of male participants (OR=1.20 [1.14, 1.27]) and each additional percentage point in the prevalence of hypertension (OR=1.19 [1.12, 1.27]), dyslipidemia (OR=1.09 [1.07, 1.11]), and smoking (OR=1.09 [1.05, 1.13]) were independently associated with increased AMI risk in HIV-infected adults.

Chronic HIV infection is associated with a two-fold higher AMI risk. Traditional risk factors such as hypertension, dyslipidemia, and smoking are significant contributors to AMI risk among HIV-infected adults and should be aggressively targeted in routine HIV care.