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RESEARCH PRODUCT

270 Increased hospital mortality in HIV-infected patients with acute coronary or cerebrovascular syndromes. Analysis from a French nationwide hospital medical information database

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Background After more than two decades of the AIDS epidemic, the spectrum of HIV-associated vascular diseases has considerably evolved from infectious disease with improved survival, to premature atherosclerosis. As a consequence, acute atherosclerosis complications, such as acute coronary and cerebrovascular syndromes (ACS and CVS) are currently growing. However, only few data are available on HIV-infected patients in the setting of ACS/CVS. The aim of the present study was to determine the prevalence of HIV, as well as the characteristics and hospital case fatality of HIV-infected patients with CVS and ACS. Methods From the French nationwide hospital medical information database, data from all the consecutive patients hospitalized in the 1546 French hospital/clinics for CVS and/or ACS from 1 st January 2005 to 31 st December 2008 were analysed. Findings Among the 1.189,043 patients included, the prevalence of HIV infection was similar in CVS (0.21%) and ACS (0.19) patients (p = 0.0897). HIV patients were younger, and more frequently male. When compared to HIV-uninfected patients, case fatality was markedly increased in HIV-infected patients after either CVS (OR (95%CI): 1.73(1.45–2.06)) or ACS (OR (95%CI): 1.37(1.01–1.86)), even after adjustment for sex and age or sex, age, and STEMI, respectively. Conclusion The management of HIV infection is now focusing on long-term follow-up over decades. HIV infection is associated with dramatically worse hospital prognosis for both ACS and CVS. It is therefore evident that in HIV-infected patients, vascular disease should remain a focus for clinical and basic research not only for prevention, but also with regard to acute atherosclerosis-related complications. HIV-uninfected n = 1161124 HIV Infected n = 2356 P CVS 636728 (99.79%) 1333 (0.21%) Age (years, mean  ±  SD) 72.4 ± 14.9 49.5 ± 12.0 Men 50.0% 73.1% Case fatality 12.2% 11.1% =0.2351 ACS 524396(99.81%) 1023(0.19%) Age (years, mean  ±  SD) 68.9 ± 14.1 51.7 ± 10.7 Men 65.4% 89.3% STEMI 42.9% 57.6% Case fatality 6.6% 4.4% =0.0041