Association of Immunologic and Virologic Factors With Myocardial Infarction Rates in a US Healthcare System

Background: The effects of immunologic and virologic factors on acute myocardial infarction (AMI) rates in patients with HIV are unclear. Methods: HIV-infected patients in a US healthcare system were assessed for AMI. Results: Of 6517 patients with HIV, 273 (4.2%) had an AMI. In a model adjusting for cardiovascular risk factors, antiretroviral medications, and HIV parameters, CD4 count less than 200/mm(3) (odds ratio, 1.74; 95% confidence interval, 1.07 to 2.81; P = 0.02) predicted AMI. Increased HIV viral load was associated with AMI accounting for cardiovascular disease risk factors and antiretroviral medications but was not significant when CD4 count was considered. Conclusions: Immunologic control appears to be the most important HIV-related factor associated with AMI.