While there is increased risk of cardiovascular disease (CVD) in HIV-positive patients, aspirin use has not been studied in this group. Sujit Suchindran and colleagues from Massachusetts General Hospital presented results from a retrospective a cohort analysis of around 3,700 HIV-positive patients and 33,000 HIV-negative controls without known baseline coronary heart disease, followed from 2000 to 2009 in a U.S. healthcare cohort.1
They investigated use of aspirin whether it reduced incidence of cardiovascular disease. They found that aspirin use was lower in HIV patients, particularly men and those with highest cardiovascular disease risk. However, aspirin use had no obvious effect in reducing myocardial infarction in HIV-positive patients compared to the HIV-negative individuals.
Aspirin use was recorded as being slightly but significantly lower among HIV-positive people compared to HIV-negative controls (12.4% vs 15.3%, p <0.001) although the difference was driven by lower use by HIV-positive men rather than women. It was more almost 50% lower amongst higher risk patients with two or more coronary heart disease risk factors (22.1% vs 42.4%, p <0.001), with similarly reduced use byt both HIV-positive men and women.
In multivariate analyses, aspirin use was only associated with reduced risk of myocardial infarction amongst HIV-negative patients with no association of protection in overall HIV group or any subgroup.
Aspirin use was lower amongst HIV-positive patients compared to HIV-negative patients with a greater relative difference amongst those with significant cardiovascular risk. Although benefit was not demonstrated in HIV-positive patients, this was an observational study with potential for selection bias especially with data dependent on hospital inpatient and outpatient prescription registries.
In the absence of evidence from randomised studies, aspirin use should probably be considered in HIV-positive patients for similar indications as the general population.
Unless stated otherwise, all references are to the Programme and Abstracts of the 20th Conference on Retroviruses and Opportunistic Infections, 3-6 March 2013, Altanta, GA.
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Satyajit Das is with University Hospital Coventry.