People living with HIV are at a greater risk for incident heart failure, with those with higher viral loads and lower CD4+ T cell counts having the greatest risk.
People living with HIV are twice as likely to develop cardiovascular disease than noninfected individuals. According to a new study, they are also more likely to have incident heart failure (HF) than the general population, even after adjustment for demographics and cardiovascular risk factors.
The study researchers analyzed 4640 people living with HIV and 4650 uninfected controls receiving care at Northwestern Medicine from January 1, 2000, to July 12, 2016. Physicians reviewed patient data from available medical records to identify heart failure diagnoses. Follow up was carried out until incident HF, death, or, the most recent clinical encounter through July 12, 2016, for people without incident HF or death.
At baseline 33.7% of people with HIV were taking antiretroviral therapy (ART), and the first measured viral load was undetectable for 53.5%. The overwhelming majority (87.2%) used ART during follow-up, and 48.3% used a protease inhibitor during follow-up.
Of the studied people living with HIV, 886 screened as having possible HF, of which 97 were determined to have incident HF. Meanwhile, 775 of the uninfected controls screened as having possible HF, of which 55 were determined to have incident HF.
A multivariable-adjusted analysis determined that people living with HIV were more than 2 times more likely to have incident HF than the controls, even after adjustment for age, sex, race/ethnicity, baseline body mass index, hypertension, diabetes, year of study entry, and coronary heart disease.
Looking at subpopulations within the HIV cohort, the researchers observed that higher viral load was associated with a significantly greater incidence of HF and higher CD4+ T cell count was associated with a significantly lower incidence of HF.
As patients adhering to ART typically have lower viral loads and higher CD4+ T cell counts, “this illustrates the public health importance of prompt HIV diagnosis, early ART initiation, and strict ART adherence in this population,” explained the researchers.
However, they noted, HF risk was still heightened in those with low or undetectable loads and with CD4 counts ≥500 cells/mm3, suggesting that HIV-related viremia and immune dysfunction may cause HIV-associated HF. They added they inflammation and immune activation are hallmarks of HIV infection, even in the absence of peripherally detectable viremia, and also factors in HF among the general population.
Feinstein M, Steverson A, Ning H, et al. Adjudictated heart failure in HIV-infected and uninfected men and women [published online November 1, 2018]. JAHA. doi: 10.1161/JAHA.118.009985.