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Human Immunodeficiency Virus Infection and Variation in Heart Failure Risk by Age, Sex, and Ethnicity: The HIV HEART Study

Published:December 13, 2021DOI:https://doi.org/10.1016/j.mayocp.2021.10.004

      Abstract

      Objectives

      To evaluate the risk of heart failure (HF) linked to human immunodeficiency virus (HIV) infection, how risk varies by demographic characteristics, and whether it is explained by atherosclerotic disease or risk factor treatment.

      Patients and Methods

      We performed a retrospective cohort study of persons with HIV (PWHs) from January 1, 2000, through December 31, 2016, frequency-matched 1:10 to persons without HIV on year of entry, age, sex, race/ethnicity, and treating facility. We evaluated the risk of incident HF associated with HIV infection, overall and by left ventricular systolic function, and whether HF risk varied by demographic characteristics.

      Results

      Among 38,868 PWHs and 386,586 matched persons without HIV, mean ± SD age was 41.4±10.8 years, with 12.3% female, 21.1% Black, 20.5% Hispanic, and 3.9% Asian/Pacific Islander. During median follow-up of 3.8 years (interquartile range, 1.4-9.0 years), the rate (per 100 person-years) of incident HF was 0.23 in PWHs vs 0.15 in those without HIV (P<.001). The PWHs had a higher adjusted HF rate (adjusted hazard ratio [aHR], 1.73; 95% confidence interval [CI], 1.57 to 1.91), which was only modestly attenuated after accounting for interim acute coronary syndrome events. Results were similar by systolic function category. The adjusted risk of HF in PWHs was more prominent for those 40 years and younger (aHR, 2.45; 95% CI, 1.92 to 3.03), women (aHR, 2.48; 95% CI, 1.90 to 3.26), and Asian/Pacific Islanders (aHR, 2.46; 95% CI, 1.27 to 4.74).

      Conclusion

      HIV infection increases the risk of HF, which varied by demographic characteristics and was not primarily mediated through atherosclerotic disease pathways or differential use of cardiopreventive medications.

      Abbreviations and Acronyms:

      ACS (acute coronary syndrome), aHR (adjusted hazard ratio), ART (antiretroviral therapy), ASCVD (atherosclerotic cardiovascular disease), EMR (electronic medical record), HF (heart failure), HFmrEF (heart failure with mid-range ejection fraction), HFpEF (heart failure with preserved ejection fraction), HFrEF (heart failure with reduced ejection fraction), HIV (human immunodeficiency virus), LVEF (left ventricular ejection fraction), PWH (person living with HIV), VACS-VC (Veterans Aging Cohort Study-Virtual Cohort)
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      References

        • Phillips A.N.
        • Neaton J.
        • Lundgren J.D.
        The role of HIV in serious diseases other than AIDS.
        AIDS. 2008; 22: 2409-2418
        • Klein D.
        • Hurley L.B.
        • Quesenberry Jr., C.P.
        • Sidney S.
        Do protease inhibitors increase the risk for coronary heart disease in patients with HIV-1 infection?.
        J Acquir Immune Defic Syndr. 2002; 30: 471-477
        • Freiberg M.S.
        • Chang C.C.
        • Kuller L.H.
        • et al.
        HIV infection and the risk of acute myocardial infarction.
        JAMA Intern Med. 2013; 173: 614-622
        • Silverberg M.J.
        • Leyden W.A.
        • Xu L.
        • et al.
        Immunodeficiency and risk of myocardial infarction among HIV-positive individuals with access to care.
        J Acquir Immune Defic Syndr. 2014; 65: 160-166
        • Klein D.B.
        • Leyden W.A.
        • Xu L.
        • et al.
        Declining relative risk for myocardial infarction among HIV-positive compared with HIV-negative individuals with access to care.
        Clin Infect Dis. 2015; 60: 1278-1280
        • Heidenreich P.A.
        • Albert N.M.
        • Allen L.A.
        • et al.
        Forecasting the impact of heart failure in the United States: a policy statement from the American Heart Association.
        Circ Heart Fail. 2013; 6: 606-619
        • Avula H.R.
        • Leong T.K.
        • Lee K.K.
        • Sung S.H.
        • Go A.S.
        Long-term outcomes of adults with heart failure by left ventricular systolic function status.
        Am J Cardiol. 2018; 122: 1008-1016
        • Triant V.A.
        • Lee H.
        • Hadigan C.
        • Grinspoon S.K.
        Increased acute myocardial infarction rates and cardiovascular risk factors among patients with human immunodeficiency virus disease.
        J Clin Endocrinol Metab. 2007; 92: 2506-2512
        • Lang S.
        • Mary-Krause M.
        • Simon A.
        • et al.
        HIV replication and immune status are independent predictors of the risk of myocardial infarction in HIV-infected individuals.
        Clin Infect Dis. 2012; 55: 600-607
        • Lichtenstein K.A.
        • Armon C.
        • Buchacz K.
        • et al.
        Low CD4+ T cell count is a risk factor for cardiovascular disease events in the HIV outpatient study.
        Clin Infect Dis. 2010; 51: 435-447
        • Friis-Moller N.
        • Reiss P.
        • Sabin C.A.
        • et al.
        Class of antiretroviral drugs and the risk of myocardial infarction.
        N Engl J Med. 2007; 356: 1723-1735
        • Holmberg S.D.
        • Moorman A.C.
        • Greenberg A.E.
        Trends in rates of myocardial infarction among patients with HIV.
        N Engl J Med. 2004; 350: 730-732
        • Mary-Krause M.
        • Cotte L.
        • Simon A.
        • Partisani M.
        • Costagliola D.
        Increased risk of myocardial infarction with duration of protease inhibitor therapy in HIV-infected men.
        AIDS. 2003; 17: 2479-2486
        • Worm S.W.
        • Sabin C.
        • Weber R.
        • et al.
        Risk of myocardial infarction in patients with HIV infection exposed to specific individual antiretroviral drugs from the 3 major drug classes: the data collection on adverse events of anti-HIV drugs (D:A:D) study.
        J Infect Dis. 2010; 201: 318-330
        • Lang S.
        • Mary-Krause M.
        • Cotte L.
        • et al.
        Impact of individual antiretroviral drugs on the risk of myocardial infarction in human immunodeficiency virus-infected patients: a case-control study nested within the French Hospital Database on HIV ANRS cohort CO4.
        Arch Intern Med. 2010; 170: 1228-1238
        • Sabin C.A.
        • Worm S.W.
        • Weber R.
        • et al.
        Use of nucleoside reverse transcriptase inhibitors and risk of myocardial infarction in HIV-infected patients enrolled in the D:A:D study: a multi-cohort collaboration.
        Lancet. 2008; 371: 1417-1426
        • Butt A.A.
        • Chang C.C.
        • Kuller L.
        • et al.
        Risk of heart failure with human immunodeficiency virus in the absence of prior diagnosis of coronary heart disease.
        Arch Interl Med. 2011; 171: 737-743
        • Freiberg M.S.
        • Chang C.H.
        • Skanderson M.
        • et al.
        Association between HIV infection and the risk of heart failure with reduced ejection fraction and preserved ejection fraction in the antiretroviral therapy era: results from the Veterans Aging Cohort Study.
        JAMA Cardiol. 2017; 2: 536-546
        • Allen L.A.
        • Magid D.J.
        • Gurwitz J.H.
        • et al.
        Risk factors for adverse outcomes by left ventricular ejection fraction in a contemporary heart failure population.
        Circ Heart Fail. 2013; 6: 635-646
        • Saczynski J.S.
        • Go A.S.
        • Magid D.J.
        • et al.
        Patterns of comorbidity in older adults with heart failure: the Cardiovascular Research Network PRESERVE study.
        J Am Geriatr Soc. 2013; 61: 26-33
        • Smith D.H.
        • Thorp M.L.
        • Gurwitz J.H.
        • et al.
        Chronic kidney disease and outcomes in heart failure with preserved versus reduced ejection fraction: the Cardiovascular Research Network PRESERVE Study.
        Circ Cardiovasc Qual Outcomes. 2013; 6: 333-342
        • McKee P.A.
        • Castelli W.P.
        • McNamara P.M.
        • Kannel W.B.
        The natural history of congestive heart failure: the Framingham study.
        N Engl J Med. 1971; 285: 1441-1446
        • Redfield M.M.
        • Jacobsen S.J.
        • Burnett Jr., J.C.
        • Mahoney D.W.
        • Bailey K.R.
        • Rodeheffer R.J.
        Burden of systolic and diastolic ventricular dysfunction in the community: appreciating the scope of the heart failure epidemic.
        JAMA. 2003; 289: 194-202
        • Yancy C.W.
        • Jessup M.
        • Bozkurt B.
        • et al.
        2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.
        J Am Coll Cardiol. 2013; 62: e147-e239
        • Go A.S.
        • Yang J.
        • Gurwitz J.H.
        • Hsu J.
        • Lane K.
        • Platt R.
        Comparative effectiveness of different beta-adrenergic antagonists on mortality among adults with heart failure in clinical practice.
        Arch Intern Med. 2008; 168: 2415-2421
        • Go A.S.
        • Lee W.Y.
        • Yang J.
        • Lo J.C.
        • Gurwitz J.H.
        Statin therapy and risks for death and hospitalization in chronic heart failure.
        JAMA. 2006; 296: 2105-2111
        • Feinstein M.J.
        • Steverson A.B.
        • Ning H.
        • et al.
        Adjudicated heart failure in HIV-infected and uninfected men and women.
        J Am Heart Assoc. 2018; 7e009985
        • Yen Y.F.
        • Ko M.C.
        • Yen M.Y.
        • et al.
        Human immunodeficiency virus increases the risk of incident heart failure.
        J Acquir Immune Defic Syndr. 2019; 80: 255-263
        • Alonso A.
        • Barnes A.E.
        • Guest J.L.
        • Shah A.
        • Shao I.Y.
        • Marconi V.
        HIV infection and incidence of cardiovascular diseases: an analysis of a large healthcare database.
        J Am Heart Assoc. 2019; 8e012241
        • Abelman R.A.
        • Mugo B.M.
        • Zanni M.V.
        Conceptualizing the risks of coronary heart disease and heart failure among people aging with HIV: sex-specific considerations.
        Curr Treat Options Cardiovasc Med. 2019; 21: 41
        • Lai Y.J.
        • Chen Y.Y.
        • Huang H.H.
        • Ko M.C.
        • Chen C.C.
        • Yen Y.F.
        Incidence of cardiovascular diseases in a nationwide HIV/AIDS patient cohort in Taiwan from 2000 to 2014.
        Epidemiol Infect. 2018; 146: 2066-2071
        • Zanni M.V.
        • Awadalla M.
        • Toribio M.
        • et al.
        Immune correlates of diffuse myocardial fibrosis and diastolic dysfunction among aging women with human immunodeficiency virus.
        J Infect Dis. 2020; 221: 1315-1320
        • Toribio M.
        • Neilan T.G.
        • Awadalla M.
        • et al.
        Intramyocardial triglycerides among women with vs without HIV: hormonal correlates and functional consequences.
        J Clin Endocrinol Metab. 2019; 104: 6090-6100
        • Luo L.
        • Zeng Y.
        • Li T.
        • et al.
        Prospective echocardiographic assessment of cardiac structure and function in Chinese persons living with HIV.
        Clin Infect Dis. 2014; 58: 1459-1466
        • Centers for Disease Control and Prevention
        HIV Surveillance Report, 2016. Vol 28. US Department of Health and Human Services, 2017
        • Thompson M.A.
        • Horberg M.A.
        • Agwu A.L.
        • et al.
        Primary care guidance for persons with human immunodeficiency virus: 2020 update by the HIV Medicine Association of the Infectious Diseases Society of America.
        Clin Infect Dis. 2020; : ciaa1391
        • Ledwidge M.
        • Gallagher J.
        • Conlon C.
        • et al.
        Natriuretic peptide-based screening and collaborative care for heart failure: the STOP-HF randomized trial.
        JAMA. 2013; 310: 66-74
        • Ntusi N.
        • O'Dwyer E.
        • Dorrell L.
        • et al.
        HIV-1-related cardiovascular disease is associated with chronic inflammation, frequent pericardial effusions, and probable myocardial edema.
        Circ Cardiovasc Imaging. 2016; 9e004430
        • Cheung J.Y.
        • Gordon J.
        • Wang J.
        • et al.
        Mitochondrial dysfunction in human immunodeficiency virus-1 transgenic mouse cardiac myocytes.
        J Cell Physiol. 2019; 234: 4432-4444
        • Alvi R.M.
        • Neilan A.M.
        • Tariq N.
        • et al.
        Protease inhibitors and cardiovascular outcomes in patients with HIV and heart failure.
        J Am Coll Cardiol. 2018; 72: 518-530