Leukocyte Count and Coronary Artery Disease Events in People With Human Immunodeficiency Virus: A Longitudinal Study.

BACKGROUND

People with human immunodeficiency virus (HIV; PWH) have increased cardiovascular risk. Higher leukocyte count has been associated with coronary artery disease (CAD) events in the general population. It is unknown whether the leukocyte-CAD association also applies to PWH.

METHODS

In a case-control study nested within the Swiss HIV Cohort Study, we obtained uni- and multivariable odds ratios (OR) for CAD events, based on traditional and HIV-related CAD risk factors, leukocyte count, and confounders previously associated with leukocyte count.

RESULTS

We included 536 cases with a first CAD event (2000-2021; median age, 56 years; 87% male; 84% with suppressed HIV RNA) and 1464 event-free controls. Cases had higher latest leukocyte count before CAD event than controls (median [interquartile range], 6495 [5300-7995] vs 5900 [4910-7200]; P < .01), but leukocytosis (>11 000/µL) was uncommon (4.3% vs 2.1%; P = .01). In the highest versus lowest leukocyte quintile at latest time point before CAD event, participants had univariable CAD-OR = 2.27 (95% confidence interval, 1.63-3.15) and multivariable adjusted CAD-OR = 1.59 (1.09-2.30). For comparison, univariable CAD-OR for dyslipidemia, diabetes, and recent abacavir exposure were 1.58 (1.29-1.93), 2.19 (1.59-3.03), and 1.73 (1.37-2.17), respectively. Smoking and, to a lesser degree, alcohol and ethnicity attenuated the leukocyte-CAD association. Leukocytes measured up to 8 years before the event were significantly associated with CAD events.

CONCLUSIONS

PWH in Switzerland with higher leukocyte counts have an independently increased risk of CAD events, to a degree similar to traditional and HIV-related risk factors.

Informations de copyright

© The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America.

Déclaration de conflit d'intérêts

Potential conflicts of interest. B. L. received personal fees from Kantonsspital Baselland (for consultancy and statistical analyses), Liestal, Switzerland, during the conduct of the study, and reports personal fees from Gilead Switzerland SARL for lectures and ViiV for advisory board service, outside the submitted work. I. C. S.'s institution received a lecture fee from ViiV, outside the submitted work. P. R., through his institution, has received independent scientific grant support from Gilead, ViiV, Merck (all investigator-initiated study grants), and Janssen, honorarium paid to institution for lecture (content fully under author's control) from Merck & Co and has served on scientific advisory boards for Gilead, ViiV, and Merck, for which his institution has received remuneration. E. B. has received consulting fees from Gilead, MSD, ViiV, Pfizer, and AbbVie and travel support from Gilead, MSD, ViiV Healthcare, Abbvie, and Pfizer AG, and reports grants or contracts from Merck Sharp & Dohme and participation on a Data Safety Monitoring Board or Advisory Board with Merck Sharp & Dohme, Gilead Sciences, ViiV Healthcare, Pfizer AG, Ely Lilly, and Moderna, all paid to their institution and all outside the submitted work. D. L. B. received honoraria for advisory boards from Gilead, ViiV, and MSD and consulting fees from ViiV, Gilead, MSD, Pfizer, and Astra Zeneka. M. C. reports grants/support from Gilead, MSD, and ViiV, payment for expert testimony from Gilead, MSD, and ViiV, and travel support from Gilead, all paid to their institution and all outside the submitted work. R. K. reports grants/support from Gilead, paid to their institution, and grants or contracts from Swiss National Science Foundation, National Institutes of Health, outside the submitted work. H. F. G., outside this study, reports grants from Gilead (unrestricted research grant), the National Institutes of Health and the Yvonne Jacob Foundation (Swiss National Science Foundation, Swiss HIV Cohort Study), all paid to their institution; personal fees as an advisor/consultant for Merck, ViiV, and Gilead, and data and safety monitoring board remuneration from Merck, paid to their institution, and a travel grant from Gilead Sciences, paid to author, and paid participation on a Data Safety Monitoring Board or Advisory Board for Merck, Gilead Sciences, ViiV, Janssen, Johnson and Johnson, Novartis, and GSK, all outside the submitted work. P. E. T.'s institution reports unrestricted and educational grants from Gilead, ViiV, and MSD, and advisory fees from Gilead and ViiV, and payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Gilead, ViiV, MSD, and Daiichi Sankyo, all outside the submitted work. C. M. reports speaker honoraria from MSD, ViiV, and Pfizer, unrelated to this work. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.