Higher MI Mortality in Hospitalized HIV Patients

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Reasons for Increased Risk Are Unclear

Dr. Howard Edelstein

The higher rate of in-hospital MI mortality in HIV-infected patients may be due to risk factors other than HIV infection itself. Many of these patients use illicit drugs and they’re in and out of care, disenfranchised, or don’t have access to medical care. We know that people with very limited resources don’t do as well with any diagnosed illness.

There may or may not be some truth to an underlying role of inflammation related to HIV infection in driving the higher rate of death, but we haven’t really locked that down yet, especially for early infection.

I’m not sure that these results show that HIV infection is the cause of the increased risk for fatal in-hospital acute MI. The risk may be related to HIV, but it may also be related to lifestyles and other risk factors.

Dr. Howard Edelstein is an infectious diseases specialist at Alameda County Medical Center, Oakland, Calif. He reported having no financial disclosures.



SAN FRANCISCO – Hospitalized patients who have an acute MI are 53% more likely to die if they are infected with HIV, based on a secondary analysis of data from the Nationwide Inpatient Sample database.

The mortality rates for in-hospital acute MI were 4.3% for HIV-positive patients and 2.4% for HIV-negative ones, a statistically significant difference.

Dr. Daniel Pearce

HIV-positive patients had a greater burden of comorbidities, as evidenced by a mean Charlson’s Comorbidity Index score of 1.14, as compared with HIV-negative patients with an average score of 0.94. Comorbidities that were significantly more prevalent in the HIV-positive cases, compared with HIV-negative cases, included renal disease (13% vs. 5%, respectively), mild liver disease (8% vs. 1%), and heart failure (26% vs. 20%), Dr. Daniel Pearce reported at the meeting, sponsored by the American Society for Microbiology.

He and his associates analyzed data from 1997 to 2006 for nearly 1.5 million adults who were hospitalized for more than a day and had an acute MI. The data approximated a stratified 20% sample of all nonfederal, short-term, general, and specialty hospitals serving adults in the United States.

The hazard ratio for death after MI was 53% higher among the 5,984 HIV-positive patients, compared with those without HIV after adjusting for the effects of age, race, gender, comorbidity, and type of insurance (as a marker for socioeconomic status), Dr. Pearce, of the Riverside County (Calif.) Department of Public Health, and his associates reported in a poster presentation at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

The HIV-positive group was significantly younger compared with the HIV-negative group (mean ages of 54 and 64 years, respectively), more likely to be male (65% vs. 72%), and more likely to be insured primarily by Medicare or Medicaid (62% vs. 25%).

On the other hand, the HIV-positive cases had lower rates of the most common cardiometabolic risk factors, including hypertension, diabetes, and cardiac arrhythmias. Substance abuse was more prevalent in the HIV-positive group than the HIV-negative group.

Dr. Pearce speculated the higher death rate could be related to the pathological effects of HIV viremia on cardiac vasculature and function.

Dr. Pearce reported having no financial disclosures.

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