Heart failure and adverse heart failure outcomes among persons living with HIV in a US tertiary medical center

Abstract

Background: Persons living with HIV (PLHIV) have an increased risk of heart failure (HF). However, little is known about outcomes among PLHIV with HF. The study aim was to compare HF outcomes among PLHIV with HF versus individuals without HIV with HF.

Methods: Our cohort included 2,308 individuals admitted with decompensated HF. We compared baseline characteristics, 30-day HF readmission, and cardiovascular (CV) and all-cause mortality. Within PLHIV, we assessed outcomes stratified between CD4 count and viral load (VL), and tested the association between traditional and HIV-specific parameters with 30-day HF readmission.

Results: There were 374 (16%) PLHIV with HF. Among PLHIV, 92% were on antiretroviral therapy and 63% had a VL <200 copies/mL. Groups were similar with respect to age, sex, race/ethnicity, and CV risk factors. In follow-up, PLHIV had increased 30-day HF readmission (49% vs 32%) and CV (26% vs 13.5%) and all-cause mortality rates (38% vs 22%). Among PLHIV, cocaine use, HIV-specific parameters (CD4, VL), and coronary artery disease were predictors of 30-day HF readmission. Specifically, among PLHIV, those with detectable VL had higher 30-day HF readmission and CV mortality, whereas PLHIV with undetectable VL had a similar 30-day HF readmission rate and CV mortality to uninfected controls with HF. Similar outcomes were observed across strata of left ventricular ejection fraction and by CD4.

Conclusions: PLHIV with a low CD4 count or detectable VL have an increased 30-day HF readmission rate as well as increased CV and all-cause mortality. In contrast, PLHIV with a higher CD4 count and undetectable VL have similar HF outcomes to uninfected controls.

Figure 1 legend:

Consort diagram for the study. ADHF = Acute decompensated heart failure. Pts = Patients, CV = Cardiovascular, PLHIV = Persons living with Human immunodeficiency virus. LVEF = left ventricular ejection fraction. HFrEF= Heart failure with reduced ejection fraction, HFpEF= Heart failure with preserve ejection fraction, HFbEF= Heart failure with borderline ejection fraction.

Figure 2 legend:

Kaplan Meier survival curves comparing 30-day readmission among (A) PLHIV with CD4 count <200 cells /mm³ and ≥200 cells /mm³ with uninfected controls, (B) PLHIV with detectable and undetectable viral load with uninfected controls.

Figure 3 legend:

Kaplan Meier survival curves comparing CV mortality among (A) PLHIV with CD4 count <200 cells /mm³ and ≥200 cells /mm³ with uninfected controls, (B) PLHIV with detectable and undetectable viral load with uninfected controls.

Figure 4 legend:

Kaplan Meier survival curves comparing all-cause mortality among (A) PLHIV with CD4 count <200 cells /mm³ and ≥200 cells /mm³ with uninfected controls, (B) PLHIV with detectable and undetectable viral load with uninfected controls.