Importance: Whether people infected with human immunodeficiency virus (HIV) are at an increased risk of acute myocardial infarction (AMI) compared with uninfected people is not clear. Without demographically and behaviorally similar uninfected comparators and without uniformly measured clinical data on risk factors and fatal and nonfatal AMI events, any potential association between HIV status and AMI may be confounded.Objective: To investigate whether HIV is associated with an increased risk of AMI after adjustment for all standard Framingham risk factors among a large cohort of HIV-positive and demographically and behaviorally similar (ie, similar prevalence of smoking, alcohol, and cocaine use) uninfected veterans in care.

Background: Studies suggest HIV infected (HIV+) people have similar rates of major adverse cardiovascular events (MACE) after AMI and/or after percutaneous coronary interventions (PCI) compared to uninfected (HIV-) people. However, these studies were limited by a lack of CD4 cell count and/or stent type data. Low CD4 cell count and bare metal stents (BMS) are associated with higher MACE rates than high CD4 cell count and drug eluding stents (DES), respectively. Our study compared the rates and risk of MACE and mortality after PCI between HIV+ and HIV- stratified by stent type and CD4 cell count. Methods: We included 611 HIV+ and 1,564 HIV- from the Veterans Aging Cohort Study Virtual Cohort, a prospective, longitudinal, observational study of HIV+ and 1:2 matched HIV- who underwent PCI with stent placement between 1/2002-1/2010. 1-year incidence rates (IR) per 1000 person years and 95% confidence intervals (CI) for MACE and mortality were calculated by HIV and CD4 (<200/≥200 cells/mm3) status and stent type (BMS vs. DES). To compare 1-year MACE and mortality between HIV+ with CD4 <200 and ≥200 to HIV-, hazard ratios (HR) were generated from multivariate Cox proportional hazards models adjusted for age, gender, race/ethnicity, hypertension, diabetes, dyslipidemia, smoking, hepatitis C, renal disease, anemia, and substance use. MACE was defined as a composite of repeat PCI, CABG, AMI using ICD9 and ICD10 codes and all-cause mortality. Results: There were 594 MACE including 108 deaths after PCI. Percent receiving DES was similar by HIV status (57% in HIV+ vs. 56% in HIV-). MACE rates were higher among those who received BMS (429.0, 95% CI 383.8-479.5) compared to DES (318.7, 95% CI 285.5-355.9), p=0.004 and the pattern is similar by HIV status. MACE rates were similar between HIV+ with CD4≥200 and HIV- (p=0.8), but higher for HIV+ with CD4<200 (p<0.001 compared to both HIV+ with CD4≥200 and HIV-). Mortality was also similar between HIV+ with CD4≥200 and HIV- (p=0.2), but higher for HIV+ with CD4<200 (p<0.01 compared to both HIV+ with CD4≥200 and HIV-). Adjusted HRs are shown in the table. Conclusion: Stent type received did not vary by HIV status. HIV+ with CD4<200 have worse outcomes post PCI with stent placement than both HIV- and HIV+ with CD4≥200. Management of HIV may be important for decreasing MACE and mortality after PCI.