Human Immunodeficiency Virus Infection and Incident Heart Failure: A Meta-Analysis of Prospective Studies

Abstract

Objectives: To systematically analyze available prospective evidence on the association between HIV infection and incident heart failure (HF).

Methods: A systematic search of PubMed, EMBASE, Web of Science, and manual search of relevant articles through June 1st, 2020, was conducted. Two authors independently performed full-text assessments and data extraction. The pooled relative risk with 95% confidence interval was estimated using DerSimonian and Laird random-effects models, with inverse-variance fixed-effects meta-analysis used as a sensitivity analysis. Heterogeneity was explored using subgroup analyses and meta-regressions.

Results: We included 8 reports among 8,848,569 participants with 101,335 incident cases of HF [1941 among 131,632 people living with HIV (PLWH) and 99,394 among 8,716,937 control participants]. In the overall analysis using a random-effect model, HIV infection was positively associated with incident HF [relative risk, 1.80 (95% confidence interval: 1.51 to 2.15)], although with significant heterogeneity. A similar association was observed with a fixed-effects model, 1.59 (1.50 to 1.68). In subgroup analyses, associations between HIV infection and HF were nominally stronger in younger adults (age < 50 years), women, and individuals with low CD4 count (<200 cells/mm3). Publication bias was suggested from visual examination of funnel plots, correcting for this did not abolish the association, 1.52 (1.25 to 1.85).

Conclusions: Our meta-analysis provides additional evidence that HIV is associated with an increased risk of HF, particularly among younger adults, women, and individuals with low CD4 count.

Figure 1.

Flow Diagram of Study Selection for HIV Seropositivity and Incident Heart Failure

Figure 2.

Forest Plot of the Association between HIV Seropositivity and Incident Heart Failure (Central Illustration). HF: heart failure; RR: relative risk; CI: confidence interval; D+L: DerSimonian and Laird random-effects model; I-V: inverse-variance fixed-effects mode