Background: Insomnia is common among people living with HIV (PLWH) and may be associated with increased risk of myocardial infarction (MI). This study examines the association of insomnia with MI risk by MI type among PLWH. Setting: Longitudinal, multisite cohort study of adult PLWH in care at five Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) sites in the US. Methods: Clinical data and patient-reported measures and outcomes (PROs) from PLWH in CNICS between 2005-2018 were utilized in this study. Insomnia, measured at baseline, was defined as having difficulty falling or staying asleep with bothersome symptoms. CNICS centrally adjudicates MIs using expert reviewers, with distinction between type 1 (T1MI) and type 2 MIs (T2MI). Associations between insomnia and first incident MI by MI type were measured using separate Cox proportional hazard models adjusted for age, sex, race/ethnicity, HIV viral suppression, CD4 count, traditional cardiovascular disease (CVD) risk factors (hypertension, dyslipidemia, poor kidney function, smoking), and stimulant use.Results: Among 12,436 PLWH, 48% reported insomnia. Over an average of 3.8 years of follow-up, 153 T1MIs and 105 T2MIs were identified; approximately half of T2MIs were attributed to sepsis or stimulant use. After adjustment for demographic characteristics, CVD risk factors, and stimulant 4 use, the hazard ratios for T1MI and T2MI among PLWH reporting insomnia were 1.04 (95%CI:0.75-1.45) and 1.57 (95%CI:1.05-2.36), respectively.Conclusions: PLWH reporting insomnia are at an increased risk of T2MI, but not T1MI, compared to PLWH without insomnia, highlighting the importance of distinguishing MI types among PLWH.

Among 13,506 people with HIV (PWH) over 4 years median follow-up, we observed a 1.6-fold increased risk of type-1 (T2MI) and type-2 (T2MI) myocardial infarction for current versus never smoking. Women had higher risk of T2MI than men and vice-versa.

Objectives People with HIV have a higher risk of myocardial infarction (MI) than the general population, with a greater proportion of type 2 MI (T2MI) due to oxygen demand–supply mismatch compared with type 1 (T1MI) resulting from atherothrombotic plaque disruption. People living with HIV report a greater prevalence of cigarette and alcohol use than do the general population. Alcohol use and smoking as risk factors for MI by type are not well studied among people living with HIV. We examined longitudinal associations between smoking and alcohol use patterns and MI by type among people living with HIV. Design and Methods Using longitudinal data from the Centers for AIDS Research Network of Integrated Clinical Systems cohort, we conducted time‐updated Cox proportional hazards models to determine the impact of smoking and alcohol consumption on adjudicated T1MI and T2MI. Results Among 13 506 people living with HIV, with a median 4 years of follow‐up, we observed 177 T1MI and 141 T2MI. Current smoking was associated with a 60% increase in risk of both T1MI and T2MI. In addition, every cigarette smoked per day was associated with a 4% increase in risk of T1MI, with a suggestive, but not significant, 2% increase for T2MI. Cigarette use had a greater impact on T1MI for men than for women and on T2MI for women than for men. Increasing alcohol use was associated with a lower risk of T1MI but not T2MI. Frequency of heavy episodic alcohol use was not associated with MI. Conclusions Our findings reinforce the prioritization of smoking reduction, even without cessation, and cessation among people living with HIV for MI prevention and highlight the different impacts on MI type by gender.

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