Article

Acute coronary syndromes in human immunodeficiency virus patients: a meta-analysis investigating adverse event rates and the role of antiretroviral therapy.

Division of Cardiology, University of Turin, S. Giovanni Battista 'Molinette' Hospital, Corso Bramante 88-90, Turin 10126, Italy.
European Heart Journal (impact factor: 10.48). 12/2011; 33(7):875-80. DOI:10.1093/eurheartj/ehr456 pp.875-80
Source: PubMed

ABSTRACT Highly active antiretroviral therapy (HAART) dramatically reduces human immunodeficiency virus (HIV)-associated morbidity and mortality, but adverse effects of HAART are becoming an increasing challenge, especially in the setting of acute coronary syndromes (ACS). We thus performed a comprehensive review of studies focusing on ACS in HIV patients.
MEDLINE/PubMed was systematically screened for studies reporting on ACS in HIV patients. Baseline, treatment, and outcome data were appraised and pooled with random-effect methods computing summary estimates [95% confidence intervals (CIs)]. A total of 11 studies including 2442 patients were identified, with a notably low prevalence of diabetes [10.86 (4.11, 17.60); 95% CI]. Rates of in-hospital death were 8.00% (2.8, 12.5; 95% CI), ascribable to cardiovascular events for 7.90% (2.43, 13.37; 95% CI), with 2.31% (0.60, 4.01; 95% CI) developing cardiogenic shock. At a median follow-up of 25.50 months (11.25, 42; 95% CI), no deaths were recorded, with an incidence of 9.42% of acute myocardial infarction (2.68, 16.17; 95% CI) and of 20.18% (9.84, 30.51; 95% CI) of percutaneous coronary revascularization. Moreover, pooled analysis of the studies reporting incidence of acute myocardial infarction in patients exposed to protease inhibitors showed an overall significant risk of 2.68 (odds ratio 1.89, 3.89; 95% CI).
Human immunodeficiency virus patients admitted for ACS face a substantial short-term risk of death and a significant long-term risk of coronary revascularization and myocardial infarction, especially if receiving protease inhibitors.

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Keywords

11 studies
 
ACS face
 
active antiretroviral therapy
 
acute coronary syndromes
 
acute myocardial infarction
 
cardiovascular events
 
comprehensive review
 
coronary revascularization
 
HIV patients
 
HIV)-associated morbidity
 
human immunodeficiency virus
 
Human immunodeficiency virus patients
 
in-hospital death
 
increasing challenge
 
percutaneous coronary revascularization
 
protease inhibitors
 
random-effect methods
 
significant long-term risk
 
substantial short-term risk
 
summary estimates [95% confidence intervals