Factors Associated with Excess Myocardial Infarction Risk in HIV-Infected Adults: A Systematic Review and Meta-analysis

Shreya G. Rao, Karla I. Galaviz, Hawkins C. Gay, Jingkai Wei, Wendy S. Armstrong, Carlos Del Rio, K. M.Venkat Narayan, Mohammed K. Ali

Research output: Contribution to journalArticlepeer-review

32 Scopus citations


Objectives:To estimate the pooled relative risk (RR) of incident acute myocardial infarction (AMI) among HIV-infected adults compared with HIV-uninfected controls and explore the contribution of traditional and HIV-related risk factors.Background:Understanding AMI risk and associated risk factors in HIV-infected populations has the potential to inform clinical management and prevention strategies.Methods:We systematically identified cohort studies of HIV-infected or HIV-infected and matched uninfected adults reporting AMI incidence rates published up to January 1, 2017. Random-effects meta-analysis models were used to estimate the aggregate RR of AMI by HIV status. Subgroup analysis and meta-regression were used to explore factors affecting risk.Results:Sixteen studies (N = 1,619,690, median age 38.5 years, 78.9% male, mean follow-up of 6.5 years) were included. In pooled analyses of HIV-infected and matched uninfected cohorts (n = 5), HIV-infected individuals had higher AMI incidence rates (absolute risk difference = 2.2 cases per 1000 persons per year) and twice the risk of AMI [RR = 1.96 (1.5-2.6)] compared with matched HIV-uninfected controls. In a multivariate meta-regression, each additional percentage point in the proportion of male participants [odds ratio (OR) = 1.20 (1.14-1.27)] and each additional percentage point in the prevalence of hypertension [OR = 1.19 (1.12-1.27)], dyslipidemia [OR = 1.09 (1.07-1.11)], and smoking [OR = 1.09 (1.05-1.13)] were independently associated with increased AMI risk in HIV-infected adults.Conclusions and Relevance:Chronic HIV infection is associated with a 2-fold higher AMI risk. Traditional risk factors such as hypertension, dyslipidemia, and smoking are significant contributors to AMI risk among HIV-infected adults and should be aggressively targeted in routine HIV care.

Original languageEnglish (US)
Pages (from-to)224-230
Number of pages7
JournalJournal of Acquired Immune Deficiency Syndromes
Issue number2
StatePublished - Jun 1 2019
Externally publishedYes


  • cardiovascular disease
  • myocardial infarction, HIV

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)


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