risk management

Risk of Myocardial Infarction Is Increased in People With HIV

The risk of myocardial infarction (MI) in people with HIV has increased since newer antiretroviral therapies (ARTs) with adverse cardiovascular effects were introduced, according to the results of a recent study presented at the 2022 Conference for Antiretrovirals and Opportunistic Infections (CROI).

These agents include integrase inhibitors, which promote weight gain, and tenofovir alafenamide, which are known to elevate lipid levels.

To investigate MI rates in people with HIV, the researchers studied 2 cohorts of people with HIV (n = 10,312); 1 from Massachusetts General Hospital, and another from Kaiser Permanente Northern California (mean age of combined cohorts, 43 y). Study participants were selected from 2005 to 2017 and followed up through 2020.

Study participants also included a propensity‑matched comparison group of people without HIV (n = 23,018). Propensity scores were based on baseline demographics, such as age, race, and sex, and baseline Framingham risk score components, including total cholesterol level, high-density lipoprotein cholesterol level, diabetes, systolic blood pressure, hypertension treatment, and smoking status.

The researchers assessed the impact of HIV status on MI risk in study participants during 2 time periods: 2005 to 2009 and 2010 to 2017. They used Cox proportional hazards models to calculate adjusted hazard ratios (HRs) for the effect of HIV status on MI rate by cohort, as well as for the study population with HIV as a whole, by using people without HIV as a reference. They adjusted for age and sex only in 1 model and for demographics and Framingham risk score components in a stepwise fashion in another model.

During the study period, 238 study participants had an MI. Stepwise-adjusted models for the combined cohorts of people with HIV indicated that the HR for MI was 0.99 (0.67, 1.45) from 2005 to 2009 compared with 1.85 (1.26, 2.72) from 2010 to 2017 (P = .04).

“Data from 2 distinct US cohorts suggest increased MI risk among PWH in recent years,” concluded the researchers. “In light of known metabolic effects of newer ART regimens, continued surveillance for MIs is warranted.”


—Ellen Kurek



Silverberg MJ, Lyass A, Hurley L, et al. Trends in myocardial infarction risk by HIV status in US healthcare systems. Paper presented at: Conference on Retroviruses and Opportunistic Infections, February 12-16 and 22-24, 2022; Virtual. Accessed February 17, 2022.