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. 2021 Dec 1;1(3):oeab040.
doi: 10.1093/ehjopen/oeab040. eCollection 2021 Nov.

Human immunodeficiency virus infection and risks of morbidity and death in adults with incident heart failure

Harshith R Avula  1 , Andrew P Ambrosy  2   3 , Michael J Silverberg  3 , Kristi Reynolds  4 , William J Towner  4   5   6 , Rulin C Hechter  4   7 , Michael Horberg  8 , Suma Vupputuri  8 , Thomas K Leong  3 , Wendy A Leyden  3 , Teresa N Harrison  4 , Keane K Lee  3   9 , Sue Hee Sung  3 , Alan S Go  3   7   10   11
Affiliations

Human immunodeficiency virus infection and risks of morbidity and death in adults with incident heart failure

Harshith R Avula et al. Eur Heart J Open. .

Abstract

Aims: Human immunodeficiency virus (HIV) increases the risk of heart failure (HF), but whether it influences subsequent morbidity and mortality remains unclear.

Methods and results: We investigated the risks of hospitalization for HF, HF-related emergency department (ED) visits, and all-cause death in an observational cohort of incident HF patients with and without HIV using data from three large US integrated healthcare delivery systems. We estimated incidence rates and adjusted hazard ratios (aHRs) by HIV status at the time of HF diagnosis for subsequent outcomes. We identified 448 persons living with HIV (PLWH) and 3429 without HIV who developed HF from a frequency-matched source cohort of 38 868 PLWH and 386 586 without HIV. Mean age was 59.5 ± 11.3 years with 9.8% women and 31.8% Black, 13.1% Hispanic, and 2.2% Asian/Pacific Islander. Compared with persons without HIV, PLWH had similar adjusted rates of HF hospitalization [aHR 1.01, 95% confidence interval (CI): 0.81-1.26] and of HF-related ED visits [aHR 1.22 (95% CI: 0.99-1.50)], but higher adjusted rates of all-cause death [aHR 1.31 (95% CI: 1.08-1.58)]. Adjusted rates of HF-related morbidity and all-cause death were directionally consistent across a wide range of CD4 counts but most pronounced in the subset with a baseline CD4 count <200 or 200-499 cells/μL.

Conclusion: In a large, diverse cohort of adults with incident HF receiving care within integrated healthcare delivery systems, PLWH were at an independently higher risk of all-cause death but not HF hospitalizations or HF-related ED visits. Future studies investigating modifiable HIV-specific risk factors may facilitate more personalized care to optimize outcomes for PLWH and HF.

Keywords: Emergency department visit; Epidemiology; Heart failure; Hospitalization; Human immunodeficiency virus; Mortality.

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Figures

Graphical Abstract
Graphical Abstract
Figure 1
Figure 1
Cohort assembly of persons living with HIV and persons without HIV who were diagnosed with incident heart failure.
Figure 2
Figure 2
Kaplan–Meier curves for hospitalization for heart failure, heart failure-related emergency department visits, and all-cause death by HIV status after developing incident heart failure.
Figure 3
Figure 3
Association between HIV status, baseline CD4 count, and clinical outcomes in adults with incident heart failure. Persons living with HIV with incident heart failure were at increased risk of heart failure-related emergency department visits and all-cause death but not heart failure hospitalizations compared with persons without HIV. These findings were directionally consistent across a wide range of baseline CD4 counts but may be more pronounced among the subset of patients with the highest levels of immunosuppression.
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