Clinical Outcomes After Acute Coronary Syndromes or Revascularization Among People Living With HIV: A Systematic Review and Meta-Analysis

• Published in: JAMA network open 2024-05, Vol.7 (5), p.e2411159
• Main Authors: Haji, Mohammed, Capilupi, Michael, Kwok, Michael, Ibrahim, Nouran, Bloomfield, Gerald S, Longenecker, Christopher T, Rodriguez-Barradas, Maria C, Ashong, Chester N, Jutkowitz, Eric, Taveira, Tracey H, Richard, Michelle, Sullivan, Jennifer L, Rudolph, James L, Wu, Wen-Chih, Erqou, Sebhat
• Format: Article
• Language: English
• Subjects: Acute Coronary Syndrome - epidemiology; Acute Coronary Syndrome - surgery; Acute coronary syndromes; Adult; Cardiology; Clinical outcomes; Drug use; Female; Heart failure; HIV; HIV Infections - complications; HIV Infections - epidemiology; Human immunodeficiency virus; Humans; Longitudinal studies; Male; Meta-analysis; Middle Aged; Mortality; Myocardial Revascularization - statistics & numerical data; Online Only; Original Investigation; Percutaneous Coronary Intervention - statistics & numerical data; Treatment Outcome
• ISSN: 2574-3805; 2574-3805
• DOI: 10.1001/jamanetworkopen.2024.11159

Clinical outcomes after acute coronary syndromes (ACS) or percutaneous coronary interventions (PCIs) in people living with HIV have not been characterized in sufficient detail, and extant data have not been synthesized adequately. To better characterize clinical outcomes and postdischarge treatment of patients living with HIV after ACS or PCIs compared with patients in an HIV-negative control group. Ovid MEDLINE, Embase, and Web of Science were searched for all available longitudinal studies of patients living with HIV after ACS or PCIs from inception until August 2023. Included studies met the following criteria: patients living with HIV and HIV-negative comparator group included, patients presenting with ACS or undergoing PCI included, and longitudinal follow-up data collected after the initial event. Data extraction was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. Clinical outcome data were pooled using a random-effects model meta-analysis. The following clinical outcomes were studied: all-cause mortality, major adverse cardiovascular events, cardiovascular death, recurrent ACS, stroke, new heart failure, total lesion revascularization, and total vessel revascularization. The maximally adjusted relative risk (RR) of clinical outcomes on follow-up comparing patients living with HIV with patients in control groups was taken as the main outcome measure. A total of 15 studies including 9499 patients living with HIV (pooled proportion [range], 76.4% [64.3%-100%] male; pooled mean [range] age, 56.2 [47.0-63.0] years) and 1 531 117 patients without HIV in a control group (pooled proportion [range], 61.7% [59.7%-100%] male; pooled mean [range] age, 67.7 [42.0-69.4] years) were included; both populations were predominantly male, but patients living with HIV were younger by approximately 11 years. Patients living with HIV were also significantly more likely to be current smokers (pooled proportion [range], 59.1% [24.0%-75.0%] smokers vs 42.8% [26.0%-64.1%] smokers) and engage in illicit drug use (pooled proportion [range], 31.2% [2.0%-33.7%] drug use vs 6.8% [0%-11.5%] drug use) and had higher triglyceride (pooled mean [range], 233 [167-268] vs 171 [148-220] mg/dL) and lower high-density lipoprotein-cholesterol (pooled mean [range], 40 [26-43] vs 46 [29-46] mg/dL) levels. Populations with and without HIV were followed up for a pooled mean (range) of 16.2 (3.0-60.8) months and 11.9 (3.0-60.8) months