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Session 91 Poster Session Cardiovascular Disease Risk Session Time: 4:30-6:30 pm Room 4E-F

696-T. Hospitalizations for Coronary Heart Disease and Myocardial Infarction among HIV+ Patients in the HAART Era D. Klein*,, and L. Hurley Kaiser Permanente Med. Care Program, Oakland, CA Background: Concern persists that antiretroviral therapy (ART), particularly protease inhibitors (PI) may increase risk for coronary heart disease (CHD) among HIV+ patients. We previously reported no difference in CHD hospitalization rates among HIV+ patients regardless of PI exposure. Now with up to 5.5 years of follow-up, we report up-dated hospitalization rates for CHD and myocardial infarction (MI). We also report prevalence of classic CHD risk factors. Methods: Hospital events for CHD (ICD9 410-414, primary discharge diagnosis) including MI were identified among HIV+ males (cases) and among a sample of males not known to be HIV+ (controls). All persons studied were aged 35-64 years and members of the Kaiser Permanente Northern California HMO. Follow-up began January 1, 1996 and ended at the earliest of member termination or June 30, 2001. For cases, follow-up in person-years was assigned by treatment exposure category separately as any ART vs no ART, and as any PI vs no PI. In each comparison, cases could contribute person-years to both categories. Cases and controls with prior CHD events were excluded. Age-adjusted (1990 U.S. census) CHD and MI event rates were calculated. Risk factors were obtained from electronic medical records. Results: 4159 cases contributed 14,823 person-years of follow-up (median 4.1); 40,000 controls contributed 190,000 person-years of follow-up. There were 72 CHD events (47 Mis) among cases. Age-adjusted CHD rates, pre- vs post- any ART (5.7 vs 6.8 events/1000 person-years) and pre- vs post-PI (6.2 vs 6.7), were similar, as were MI rates pre- vs post-PI (4.4 vs 4.3). In cases vs controls, CHD rates were higher (6.5 vs 3.8 events / 1000 person-years, p=0.003) and the difference in MI rates approached significance (4.3 vs 2.9, p=0.07). Differences in proportions with classic CHD risk factors were mixed (cases vs controls): hyperlipidemia 21% vs 16%, smoking 19% vs 10%, hypertension 18% vs 25%, and diabetes 7% vs 9%. Conclusions: After 5.5 years we find no effect of treatment type on CHD or MI hospitalization rates among HMO-enrolled HIV+ men. However, the rates are higher among HIV+ vs HIV- men. This may be due to chronic infection or to other co-factors not studied here. Longer follow-up is needed and risk reduction management is warranted in all patients with multiple CHD risks.

©2002 9th Conference on Retroviruses and Opportunistic Infections