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. 2018 Nov 6;7(21):e009985.
doi: 10.1161/JAHA.118.009985.

Adjudicated Heart Failure in HIV-Infected and Uninfected Men and Women

Matthew J Feinstein  1   2 , Alexandra B Steverson  3 , Hongyan Ning  2 , Anna E Pawlowski  4 , Daniel Schneider  4 , Faraz S Ahmad  1   2 , Jes M Sanders  1 , Arjun Sinha  1 , Robin M Nance  5 , Chad J Achenbach  1 , J A Christopher Delaney  5 , Susan R Heckbert  6 , Sanjiv J Shah  1 , David B Hanna  7 , Priscilla Y Hsue  3 , Gerald S Bloomfield  8 , Chris T Longenecker  9 , Heidi M Crane  5 , Donald M Lloyd-Jones  1   2
Affiliations

Adjudicated Heart Failure in HIV-Infected and Uninfected Men and Women

Matthew J Feinstein et al. J Am Heart Assoc. .

Abstract

Background HIV is associated with elevated risk of heart failure ( HF ). Despite poor agreement between automated, administrative code-based HF definitions and physician-adjudicated HF , no studies have evaluated incident adjudicated HF for people living with HIV ( PLWH ). Methods and Results We analyzed PLWH and uninfected controls receiving care in an urban medical system from January 1, 2000, to July 12, 2016. Physicians reviewed data from medical records to adjudicate HF diagnoses. We used multivariable-adjusted Cox models to analyze incident HF for PLWH versus controls and HIV -related factors associated with incident HF . We also analyzed the performance of automated versus physician-adjudicated HF definitions. Incident adjudicated HF occurred in 97 of 4640 PLWH (2.1%; mean: 6.8 years to HF ) and 55 of 4250 controls (1.3%; mean: 6.7 years to HF ; multivariable-adjusted hazard ratio: 2.10; 95% confidence interval, 1.38-3.21). Among PLWH , higher HIV viral load ( hazard ratio per log10 higher time-updated viral load: 1.22; 95% confidence interval, 1.11-1.33) was associated with greater HF risk and higher CD 4+ T cell count was associated with lower HF risk ( hazard ratio per 100 cells/mm3 higher time-updated CD 4 count: 0.80; 95% confidence interval, 0.69-0.92). In exploratory analyses, the most accurate automated HF definitions had sensitivities of 67% to 75% and positive predictive values of 54% to 60%. Conclusions In a cohort with rigorous HF adjudication, PLWH had greater risks of HF than uninfected people after adjustment for demographics and cardiovascular risk factors. Higher HIV viral load and lower CD 4+ T cell count were associated with higher HF risk among PLWH . Automated methods of HF ascertainment exhibited poor accuracy for PLWH and uninfected people.

Keywords: HIV; heart failure; immunology; inflammation.

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Figures

Figure 1
Figure 1
Heart failure screening and adjudication in HIVE‐4CVD (HIV Electronic Comprehensive Cohort of CVD Complications). HF indicates heart failure; ICD‐9‐CM, International Classification of Diseases, Ninth Revision, Clinical Modification; ICD‐10‐CM, International Classification of Diseases, 10th Revision, Clinical Modification; NT‐proBNP, N‐terminal pro–B‐type natriuretic peptide.
Figure 2
Figure 2
Survival free of heart failure by HIV serostatus.
Figure 3
Figure 3
Characteristics of automated heart failure screening protocols in HIVE‐4CVD (HIV Electronic Comprehensive Cohort of CVD Complications) relative to the adjudicated heart failure gold standard. BNP indicates B‐type natriuretic peptide; HF, heart failure; ICD, International Classification of Diseases; PPV, positive predictive value; Se, sensitivity.
See this image and copyright information in PMC

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