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Improvements over time in short-term mortality following myocardial infarction in HIV-positive individuals.

Type of publication Peer-reviewed
Publikationsform Original article (peer-reviewed)
Author Hatleberg Camilla Ingrid, Ryom Lene, El-Sadr Wafaa, Smith Colette, Weber Rainer, Reiss Peter, Fontas Eric, Dabis Francois, Law Matthew, Monforte Antonella d'Arminio, De Wit Stephane, Mocroft Amanda, Phillips Andrew, Lundgren Jens D, Sabin Caroline, D:A:D Study Group,
Project Swiss HIV Cohort Study (SHCS)
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Original article (peer-reviewed)

Journal AIDS (London, England)
Volume (Issue) 30(10)
Page(s) 1583 - 96
Title of proceedings AIDS (London, England)
DOI 10.1097/qad.0000000000001076

Open Access

URL http://www.zora.uzh.ch/id/eprint/125199/
Type of Open Access Repository (Green Open Access)

Abstract

Few studies have described mortality and clinical outcomes after myocardial infarction (MI) in the HIV-positive population. This study evaluated changes in short-term mortality after MI in HIV-positive individuals in the D:A:D Study, and investigated possible reasons for any changes seen. Prospective cohort study. Demographic, cardiovascular disease (CVD)/HIV-related characteristics and CVD-related interventions (invasive cardiovascular procedures and drug interventions) were summarized at the time of and following an MI. Associations between calendar year and mortality in the first month after MI were identified using logistic regression with adjustment for confounders, including interventions received in the first month after MI. One thousand and eight HIV-positive individuals experiencing an MI over the period 1999-2014 were included. The absolute number of MIs decreased from 214 (1999-2002) to 154 (2011-2014). Whilst the CVD risk profile remained high over time, the HIV status improved. The use of CVD-related interventions after MI appeared to increase over time. The proportion of individuals who died in the first month after MI dropped from 26.6% in 1999-2002 to 8.4% in 2011-2014. Later calendar year was associated with decreased short-term mortality; this effect was attenuated after adjusting for CVD-related interventions received in the first month after MI [odds ratio changed from 0.88 (95% confidence interval 0.83, 0.93) to 0.97 (0.91, 1.02)]. Improvements in short-term survival after MI appear to be largely driven by improved medical management of CVD risk in HIV-positive individuals after MI. Efforts are still needed to treat CVD risk factors and increase access to CVD-related interventions.
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