HIV/AIDS • CID 2007:44 (15 June) • 1625
H I V / A I D SM A J O R A R T I C L E
Ischemic Heart Disease in HIV-Infected
and HIV-Uninfected Individuals:
A Population-Based Cohort Study
Niels Obel,1Henrik F. Thomsen,4Gitte Kronborg,2Carsten S. Larsen,5Per R. Hildebrandt,3Henrik T. Sørensen,4,6
and Jan Gerstoft1
1Department of Infectious Diseases, Rigshospitalet,
Copenhagen University Hospital, Copenhagen, and Departments of
Aarhus, Denmark; and
2Department of Infectious Diseases, Hvidovre, and
4Clinical Epidemiology and
3Department of Cardiology, Frederiksberg,
5Infectious Diseases, Aarhus University Hospital,
6Department of Epidemiology, Boston University, Boston, Massachusetts
increase in the risk of ischemic heart disease. We examined this issue in a nationwide cohort study of patients
with human immunodeficiency virus (HIV) infection and a population-based control group.
We determined the rate of first hospitalization for ischemic heart disease in all Danish patients with
HIV infection (3953 patients) from 1 January 1995 through 31 December 2004 and compared this rate with that
for 373,856 subjects in a population-based control group. Data on first hospitalization for ischemic heart disease
and comorbidity were obtained from the Danish National Hospital Registry for all study participants. We used
Cox’s regression to compute the hospitalization rate ratio as an estimate of relative risk, adjusting for comorbidity.
Although the difference was not statistically significant, patients with HIV infection who had not
initiated HAART were slightly more likely to be hospitalized for the first time with ischemic heart disease than
were control subjects (adjusted relative risk, 1.39; 95% confidence interval, 0.81–2.33). After HAART initiation,
the risk increase became substantially higher (adjusted relative risk, 2.12; 95% confidence interval, 1.62–2.76), but
the relative risk did not further increase in the initial 8 years of HAART.
Compared with the general population, HIV-infected patientsreceivingHAARThaveanincreased
risk of ischemic heart disease, but the relative risk is stable up to 8 years after treatment initiation.
There are concerns about highly active antiretroviral therapy (HAART) causing a progressive
Concerns have been raised that HIV-infected patients
of ischemic heart disease because of dyslipidemia in-
duced by the therapy [1, 2]. Two studies haveexamined
the impact of HAART on intima media thickness,mea-
sured by ultrasonography, as a marker for ischemic
heart disease, with inconsistent findings [3, 4]. Cohort
studies of ischemic heart disease in HIV-infected pa-
tients also have had conflicting results [5–11]. The lim-
itations of these studies included the use of different
Received 18 December 2006; accepted 18 February 2007; electronically
published 10 May 2007.
Reprints or correspondence: Dr. Niels Obel, Dept. of InfectiousDiseases,Odense
University Hospital, Sdr. Blvd. 29, DK-5000 Odense C, Denmark (niels
Clinical Infectious Diseases2007;44:1625–31
? 2007 by the Infectious Diseases Society of America. All rights reserved.
data sources to ascertain cases of ischemic heart disease
in the patients with HIV infection and in the control
group or the absence of control subjects from the gen-
eral population. The latter may be of particular im-
portance, because the diagnosis of ischemic heart dis-
ease has evolved during the study periods. To overcome
these methodological shortcomings, we conducted a
cohort study of ischemic heart disease in Danish pa-
tients with HIV infection and control subjects from the
general population using 3 nationwide registries: the
Danish HIV Cohort Study, the Danish Civil Registra-
tion System, and the Danish National HospitalRegistry
[12–14]. The study was designed to examine whether
HIV-infected patients receiving HAART have an ele-
vated relative risk of a first hospitalization for ischemic
heart disease, compared with the general population.
If that prediction proved to be correct,thestudyfurther
aimed to establish whether this disparity in relative risk
increased with duration of HAART.
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