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Patients With HIV, PH Had Higher Burden of Comorbidities

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The higher burden of comorbidities in patients with both HIV and pulmonary hypertension (PH) led to worse outcomes, including mortality.

Patients who had concomitant HIV and pulmonary hypertension (PH) were found to have a higher burden of comorbidities that could lead to worse outcomes overall, according to a study published in International Journal of Cardiology.

Pulmonary arterial hypertension (PAH) is a subtype of PH that has been linked to HIV in the past, with patients living with HIV having a higher risk of developing PAH vs patients not living with HIV. This study aimed to assess what the clinical characteristics and outcomes are for patients living with HIV and PH compared with patients not living with HIV and who do not have PH.

HIV Awareness Ribbon | Image credit: fizkes - stock.adobe.com

HIV Awareness Ribbon | Image credit: fizkes - stock.adobe.com

The National Inpatient Sample (NIS) was used to collect data from January 2015 to December 2019; this databse includes a 20% stratified sample of hospitalizations in the United States. All patients hospitalized in the timeframe were included and patients with concurrent HIV and PH were identified. All-cause mortality within a hospital was the primary outcome of the study, with morbidity and length of stay (LOS) included as secondary outcomes. Comorbid conditions were measured using the Charlson Comorbidity Index (CCI).

There were 910,120 patients living with HIV between 2016 and 2018 who were included in the retrospective cohort study. Among these participants, there were 28,175 patients who had PH. Patients living with both HIV and PH had a mean (SD) age of 54.53 (11.61) years compared with 49.44 (13.11) years in patients living with HIV but not PH. Patients were more likely to develop PH if they were female.

Patients with both conditions were predominantly Black (64.45%) and had a higher mean CCI (7.07 [3.53]) compared with those without PH (5.17 [3.65]). Hospital LOS was longer in people living with both HIV and PH compared with those without PH (7.61 [9.54] vs 6.11 [8.90] days). Intubation was more likely in patients who had both HIV and PH (8.06% vs 3.9%), as was tracheostomy (0.76% vs 0.43%) and higher in-hospital mortality (4.01% vs 2.28%).

Higher odds of complications were found in patients living with both HIV and PH, such as mechanical ventilation (OR, 1.71; 95% CI, 1.55-1.88), respiratory failure (OR, 3.29; 95% CI, 3.09-3.51), cardiogenic shock (OR, 5.67; 95% CI, 4.74-6.79), cardiac arrest in the hospital (OR, 1.94; 95% CI, 1.59-2.38), and heart failure (OR, 10.44; 95% CI, 9.77-11.16); sepsis and hepatic failure had no significant association with PH. Patients with both also higher odds of in-hospital mortality (OR, 1.23; 95% CI, 1.07-1.42) and in-hospital mortality within 30 days of being admitted (OR, 1.28; 95% CI, 1.07-1.42).

There were some limitations to this study. It had a retrospective design and the researchers relied on International Classification of Diseases codes to determine the diagnoses of HIV and PH in all patients. Also, specific antiretroviral therapies and the severity of PH were not evaluated for their association with clinical outcomes.

Comorbid conditions have a higher risk of being present in patients living with both HIV and PH, which can lead to worse clinical outcomes compared with patients without concurrent HIV and PH. Screening for PH in patients who have HIV can be an effective way to properly treat these comorbid conditions prior to admittance to a hospital.

Reference

Sanivarapu RR, Arjun S, Otero J, et al. In-hospital outcomes of pulmonary hyptertension in HIV patients: a population based cohort study. Int J Cardiol. Published online February 23, 2024. doi:10.1016/j.ijcard.2024.131900

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