HIV Associated With Significantly Increased Risk of Atrial Fibrillation

September 16, 2019

The researchers found that HIV significantly increases the risk of atrial fibrillation—a leading cause of stroke—at the same rate as or higher than known risk factors, including diabetes and hypertension.

Previous research has demonstrated a link between HIV and an increased risk of cardiovascular disease, including incident heart failure. Now, new study findings are adding irregular heartbeat into the mix.

The researchers of the study, reviewing a database of nearly 17.3 million people aged at least 21 years in California, found that HIV significantly increases the risk of atrial fibrillation (AF)—a leading cause of stroke—at the same rate as or higher than known risk factors, including diabetes and hypertension.

“This is the first paper demonstrating that HIV is a risk factor for AF, and the potency of that risk is similar to other well-established AF risk factors,” Gregory Marcus, MD, MAS, cardiologist at University of California, San Francisco (UCSF) Health and associate chief of cardiology for research in the UCSF Division of Cardiology, and senior author of the study, said in a statement. “Because AF can be asymptomatic and stroke may be the first manifestation, it’s important for caregivers to be aware of patients at heightened risk.”

Compared with hypertension, which carried an 89% increased risk of AF, and diabetes, which carried a 22% increased risk, having HIV put people at an 80% increased risk of irregular heartbeat.

Over an average follow-up of 4.7 years, there were 625,167 new AF diagnoses, 1076 of which occurred among the 18,000 people with HIV. All patients had received care at an outpatient surgery unit, inpatient hospital unit, or emergency department between January 2005 and December 2011.

Compared with patients without HIV, who had an incidence of 8.9 AF diagnoses per 1000 person-years, patients with HIV had an incidence of 18.2 AF diagnoses.

“Physicians caring for HIV-infected patients should be aware of this strong relationship,” said Marcus. “Increased awareness may help in recognizing the diagnosis and consequently result in more frequent prescription of appropriate therapies, such as anticoagulation, to reduce morbidity and mortality.”

There were several characteristics that further increased the risk of AF among patients with HIV, including being young, being African American or Hispanic, and not having hypertension, diabetes, or alcohol abuse.

The finding that those who were African American were at a higher risk of AF stood out to the researchers, as previous research has indicated that whites are at a significantly higher risk of AF.

Marcus added that microbial infection may also influence AF risk in patients with HIV and suggested further research to determine if antiretroviral therapies are an effective treatment.

Reference

Sardana M, Hsue P, Tseng Z, et al. Human immunodeficiency virus infection and incident atrial fibrillation [published online September 9, 2019]. J Am Coll Cardiol. doi: 10.1016/j.jacc.2019.07.027.