Estudios primarios incluidos en esta revisión sistemática

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Estudio primario

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Risk of spontaneous intracranial hemorrhage in HIV-infected individuals: a population-based cohort study.

Revista Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
Año 2013
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BACKGROUND: We studied the association between HIV infection, antiretroviral medications, and the risk of spontaneous intracranial hemorrhage. METHODS: We performed a cohort and nested case control study in an administrative database. We selected all HIV-positive individuals presenting between 1985 and 2007. Each HIV-positive subject was matched with 4 HIV-negative individuals. We used a Poisson regression model to calculate rates of intracranial hemorrhage according to HIV status. We conducted a case -control study nested within the cohort of HIV-positive individuals to look at the effect of antiretroviral medications. Odds ratios for antiretroviral exposure were obtained using conditional logistic regression. RESULTS: There were 7,053 HIV-positive and 27,681 HIV-negative subjects, representing 138,704 person-years. There were 49 incident intracranial hemorrhages, 29 in HIV-positive and 20 in HIV-negative individuals. The adjusted hazard ratio for intracranial hemorrhage in HIV-positive compared to HIV-negative patients was 3.28 (95% confidence interval [CI] 1.75-6.12). The effect was reduced to 1.99 (95% CI 0.92-4.31) in the absence of AIDS-defining conditions, and increased to 7.64 (95% CI 3.78-15.43) in subjects with AIDS-defining conditions. Hepatitis C infection, illicit drug or alcohol abuse, intracranial lesions, and coagulopathy were all strongly associated with intracranial hemorrhage (all P < .001). In the case control study, 29 cases of ICH in HIV-positive individuals were matched to 228 HIV-positive controls. None of the antiretroviral classes were associated with an increase in the odds ratio of intracranial hemorrhage. CONCLUSIONS: The risk of intracranial hemorrhage in HIV-positive individuals seems to be mostly associated with AIDS-defining conditions, other comorbidities, or lifestyle factors. No association was found between use of antiretroviral medications and intracranial hemorrhage.

Estudio primario

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Angina pectoris in patients with HIV/AIDS: prevalence and risk factors.

Revista The Brazilian journal of infectious diseases : an official publication of the Brazilian Society of Infectious Diseases
Año 2012
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INTRODUCTION: The incidence of ischemic heart disease is higher in patients with HIV/AIDS. However, the frequency of angina pectoris in these patients is still not known. Literature about this subject is still scarce. OBJECTIVE: To evaluate the prevalence of angina pectoris and risk factors for coronary disease and to examine the association between traditional risk factors and HIV-related risk factors and angina pectoris. METHOD: An epidemiological cross-sectional study, analyzed as case-control study, involving 584 patients with HIV/AIDS. Angina pectoris was identified by Rose questionnaire, classified as definite or possible. Information regarding risk factors was obtained through a questionnaire, biochemical laboratory tests, medical records and anthropometric measures taken during consultations at AIDS treatment clinics in Pernambuco, Brazil, from June 2007 to February 2008. To adjust the effect of each factor in relation to others, multiple logistic regression was used. RESULTS: There was a preponderance of men (63.2%); mean ages were 39.8 years for men, 36.8 years for women. The prevalence of definite and possible angina were 11% and 9.4%, respectively, totaling 20.4%, with independent associations between angina and smoking (OR = 2.88; 95% CI: 1.69-4.90), obesity (OR = 1.62; 95% CI: 0.97-2.70), family history of heart attack (OR = 1.70; 95% CI: 1.00-2.88), low schooling (OR = 2.11; 95% CI: 1.24-3.59), and low monthly income (OR = 2.93; 95% CI: 1.18-7.22), even after adjustment for age. CONCLUSION: This study suggests that angina pectoris is underdiagnosed, even in patients with medical monitoring, revealing lost opportunities in identification and prevention of cardiovascular morbidity.

Estudio primario

No clasificado

Ectopic fat is linked to prior cardiovascular events in men with HIV

Revista JAIDS Journal of Acquired Immune Deficiency Syndromes
Año 2012

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Estudio primario

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Relationship between Younger Age, Autoimmunity, Cardiometabolic Risk, Oxidative Stress, HAART, and Ischemic Stroke in Africans with HIV/AIDS.

Revista ISRN cardiology
Año 2011
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Background and Purpose. It now appears clear that both HIV/AIDS and antiretroviral therapy (HAART) use are associated with higher risk of cardiovascular disease such as stroke. In this study, we evaluated the prevalence, the risk factors, and the cardiometabolic comorbidities of stroke in HIV/AIDS Central African patients. Methods. This hospital-based cross-sectional study collected clinical, laboratory, and imaging data of black Central African heterosexual, intravenous drug nonuser, and HIV/AIDS patients. Results. There were 54 men and 62 women, with a female to male ratio of 1.2 : 1. All were defined by hypercoagulability and oxidative stress. Hemorrhagic stroke was reported in 1 patient, ischemic stroke in 17 patients, and all stroke subtypes in 18 patients (15%). Younger age <45 years (P = .003), autoimmunity (P < .0001), and metabolic syndrome defined by IDF criteria (P < .0001) were associated with ischemic stroke. Conclusions. Clustering of several cardiometabolic factors, autoimmunity, oxidative stress, and lifestyle changes may explain accelerated atherosclerosis and high risk of stroke in these young black Africans with HIV/AIDS. Prevention and intervention programs are needed.

Estudio primario

No clasificado

Association between HIV infection, antiretroviral therapy, and risk of acute myocardial infarction: a cohort and nested case-control study using Québec's public health insurance database.

Revista Journal of acquired immune deficiency syndromes (1999)
Año 2011
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BACKGROUND: Morbidity associated with cardiovascular disease is increasing in the HIV-infected population. We aimed to study the impact of HIV and of antiretrovirals on acute myocardial infarction (AMI). METHODS: We performed a cohort and a nested case-control study using the dataset of the Régie de l'Assurance Maladie du Québec. HIV-positive patients were identified using ICD-9 diagnostic codes and matched to HIV-negative patients. Within the HIV-positive cohort, cases of AMI were identified and matched to HIV-positive patients without AMI. The coprimary outcomes were the risk of AMI associated with HIV exposure in the cohort study and that associated with exposure to antiretrovirals in the case-control study. Data were analysed using Poisson and conditional logistic regression. RESULTS: About 7053 HIV-positive patients were matched to 27,681 HIV-negative patients. Incidence rates of AMI in the HIV+ cohort was 3.88 95% confidence interval (CI) (3.26 to 4.58) per 1000 patient-years, compared to 2.21 95% CI (1.93 to 2.52) per 1000 patient-years in the HIV cohort. The adjusted incidence ratio of AMI for HIV-infected patients was 2.11 95%CI (1.69 to 2.63). Among HIV+ patients, 125 AMI cases were matched with 1084 HIV+ patients. We found increased odds ratio (95% CI) of AMI associated with any exposure to abacavir 1.79 (1.16 to 2.76), P = 0.02, efavirenz 1.83 (1.21 to 2.76) P = 0.004, lopinavir 1.98 (1.24 to 3.16) P = 0.004, and ritonavir 2.29 (1.48 to 3.54) P < 0.001. CONCLUSIONS: HIV+ individuals were at higher risk of AMI than the general population, and several antiretrovirals were associated with an increased risk of AMI. Results should be interpreted with caution in absence of data on smoking and HIV clinical status.

Estudio primario

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Low CD4+ T cell count is a risk factor for cardiovascular disease events in the HIV outpatient study.

Revista Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
Año 2010
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BACKGROUND: Traditional cardiovascular disease (CVD) risk factors, human immunodeficiency virus (HIV) infection, and antiretroviral (ARV) agents have been associated with CVD events in HIV-infected patients. We investigated the association of low CD4(+) T lymphocyte cell count with incident CVD in a cohort of outpatients treated in 10 HIV specialty clinics in the United States. METHODS: We studied patients who were under observation from 1 January 2002 (baseline), categorized them according to National Cholesterol Education Program guidelines into 10-year cardiovascular risk score (10-y CVR) groups , and observed them until CVD event, death, last HIV Outpatient Study contact, or 30 September 2009. We calculated rates of incident CVD events and identified associated baseline risk factors using Cox proportional hazard models. We also performed a nested case-control study to examine the association of latest CD4(+) cell count with CVD events. RESULTS: Among 2005 patients, 148 experienced incident CVD events. CVD incidence increased steadily from 0.4 to 3.0 events per 100 person-years from lowest to highest 10-y CVR group (P < .001). In multivariable Cox analyses adjusted for 10-y CVR, CD4(+) cell count <350 cells/mm(3) was associated with incident CVD events (hazard ratio, 1.58 [95% confidence interval, 1.09-2.30], compared with >500 cells/mm(3)), suggesting an attributable risk of approximately 20%. In the multivariable case-control analyses, traditional CVD risk factors and latest CD4(+) cell count <500 cells/mm(3), but not cumulative use of ARV class or individual drugs, were associated with higher odds of experiencing CVD events. CONCLUSION: CD4(+) count <500 cells/mm(3) is an independent risk factor for incident CVD, comparable in attributable risk to several traditional CVD risk factors in the HIV Outpatient Study cohort.

Estudio primario

No clasificado

Análisis de graves acontecimientos no de SIDA entre los adultos infectados por el VIH en los lugares de América Latina.

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Revista HIV medicine
Año 2010
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OBJETIVO: Adquirido inmunodeficiencia parece estar asociada con graves sin SIDA (SNA) -Definir condiciones como la enfermedad cardiovascular, el hígado y la insuficiencia renal y tumores malignos no relacionadas con el SIDA. Analizamos la incidencia y los factores asociados con, varios eventos de SNA en la cohorte retrospectivo LATINA. MATERIAL Y MÉTODOS: Los casos de eventos SNA se registraron entre los pacientes de la cohorte. Tres controles fueron seleccionados para cada caso de miembros de la cohorte en riesgo. Modelos logísticos condicionales se ajustaron para estimar el efecto de los factores de riesgo tradicionales, así como los factores asociados con el VIH en condiciones no definitorias de sida. RESULTADOS: Entre 6007 pacientes en seguimiento, 130 tenían un evento SNA (0,86 eventos / 100 personas-año de seguimiento) y fueron definidos como los casos (40 con eventos cardiovasculares, de 54 años con insuficiencia hepática grave, 35 con no-SIDA -Definir las neoplasias malignas y dos con insuficiencia renal). Los factores de riesgo como la diabetes, la hepatitis B y las coinfecciones por virus C y el abuso del alcohol mostraron una asociación con eventos, como se esperaba. El último registrado CD4 recuento de células T antes de la fecha índice (P = 0,0056, con una diferencia promedio de más de 100 células / l) y el área bajo la curva de células CD4 en el año anterior a la fecha índice (P = 0,0081) fueron significativamente menor en los casos que en los controles. Recuento de células CD4 en la fecha índice se asoció significativamente con el resultado después de ajustar por factores de riesgo. Conclusiones: La incidencia y tipo de acontecimientos SNA que se encuentran en esta cohorte de América Latina son similares a los reportados en otras regiones. Se encontró una asociación significativa entre la deficiencia inmune y el riesgo de eventos SNA, incluso en pacientes en tratamiento antirretroviral.

Estudio primario

No clasificado

The association between alcohol consumption and prevalent cardiovascular diseases among HIV-infected and HIV-uninfected men.

Revista Journal of acquired immune deficiency syndromes (1999)
Año 2010
Enlaces Pubmed DOI PubMed Central

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OBJECTIVE: To determine whether alcohol consumption is associated with cardiovascular disease (CVD) among HIV-infected veterans. METHODS: Using established thresholds for alcohol consumption, we analyzed cross-sectional data from 4743 men (51% HIV infected) from the Veterans Aging Cohort Study, a prospective cohort of HIV-infected veterans and demographically similar HIV-uninfected veterans. Using logistic regression, we estimated the odds ratio (OR) for the association between alcohol consumption and prevalent CVD. RESULTS: Among HIV-infected and HIV-uninfected men, respectively, hazardous drinking (33.2% vs. 30.9%,), alcohol abuse and dependence (20.9% vs. 26.2%), and CVD (14.6% vs. 19.8%) were common. Among HIV-infected men, hazardous drinking [OR = 1.43, 95% confidence interval (CI) = 1.05 to 1.94] and alcohol abuse and dependence (OR = 1.55, 95% CI = 1.07 to 2.23) were associated with a higher prevalence of CVD compared with infrequent and moderate drinking. Among HIV-uninfected men, past drinkers had a higher prevalence of CVD (OR = 1.30, 95% CI = 1.01 to 1.67). For HIV-infected and HIV-uninfected men, traditional risk factors and kidney disease were associated with CVD. CONCLUSIONS: Among HIV-infected men, hazardous drinking and alcohol abuse and dependence were associated with a higher prevalence of CVD compared with infrequent and moderate drinking even after adjusting for traditional CVD risk factors, antiretroviral therapy, and CD4 count.

Estudio primario

No clasificado

Eventos cerebrovasculares isquémicos en pacientes infectados por el VIH-1 que reciben terapia antirretroviral de gran actividad: incidencia y factores de riesgo.

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Revista Cerebrovascular diseases (Basel, Switzerland)
Año 2009
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ANTECEDENTES: El riesgo de ACV se incrementa en pacientes con SIDA, y la terapia antirretroviral de gran actividad (TARGA) pueden acelerar la aterosclerosis, pero poco se sabe acerca de la incidencia y factores de riesgo para el accidente cerebrovascular isquémico en pacientes bajo TARGA. Hemos estudiado la incidencia, tipos de factores de riesgo de accidente cerebrovascular y posible para los eventos isquémicos cerebrovasculares en una gran cohorte de pacientes infectados por el VIH-1 tratados con TARGA. MÉTODOS: Se realizó una revisión retrospectiva de los ictus isquémicos y los ataques isquémicos transitorios que se producen en una cohorte de pacientes infectados por el VIH-1 tratados con TARGA 1996-2008. Como grupo control, se incluyeron pacientes consecutivos no seleccionados de la misma cohorte. Los pacientes y los controles fueron comparados para las variables demográficas, clínicas y de laboratorio, incluidos los factores de riesgo vascular, datos sobre la infección y la duración de la terapia HAART VIH. Las variables con diferencias significativas se incluyeron en un modelo de regresión logística. RESULTADOS: Veintisiete eventos isquémicos cerebrovasculares ocurrieron en 25 pacientes, con una incidencia de 189 eventos (166 golpes) por cada 100.000 pacientes / año. Los factores independientes asociados con eventos cerebrovasculares fueron: antecedentes de alto consumo de alcohol (OR 7,13; IC del 95%: 1,69 a 30,11; p = 0,007), un diagnóstico previo de SIDA (OR 6,61; IC del 95%: 2,03 a 21,51; p = 0,002) y un menor número de meses bajo TARGA (OR 0,97; IC del 95% desde 0,96 hasta 0,99; p <0,001). Seis pacientes (24%) tenían aterosclerosis de las grandes arterias: tenían una duración TARGA similar a los controles. Conclusiones: La incidencia de accidente cerebrovascular es alta en los pacientes con infección VIH-1 tratados con TARGA. Duración de la terapia HAART ejerce un efecto protector global para eventos isquémicos cerebrovasculares, y nuestros resultados no apoyan un papel importante en la gran carrera de la aterosclerosis de las arterias. El alto consumo de alcohol es un importante factor de riesgo para el ictus en estos pacientes.