Clinical outcomes of ventricular assist device support by HIV infection status: An STS-INTERMACS analysis

Human immunodeficiency virus infection is associated with greater risk of pneumonia and readmission after cardiac surgery

“…After multifactorial matching, authors show that HIV infection no longer impacted postimplant survival, nor was associated with postoperative stroke, bleeding, and major infection. 20 It should be noted that all patients who were HIV + receiving ventricular assist devices in their study had nondetectable viral loads. Detectable HIV viral loads may therefore serve as a dividing line between surgical eligibility and exclusion.…”

“…Recently, the mechanical support and transplant community has appreciated improving clinical progress within the HIV community. 20 , 21 No longer an absolute contradiction to transplantation, patients who are HIV + are increasingly compliant with ART therapy and have low incidence of opportunistic infections. 21 Birk and colleagues 20 recently uncovered differences in data capture between the STS Adult Cardiac Surgery Database and the Interagency Registry for Mechanically Assisted Circulatory Support Database.…”

“… 20 , 21 No longer an absolute contradiction to transplantation, patients who are HIV + are increasingly compliant with ART therapy and have low incidence of opportunistic infections. 21 Birk and colleagues 20 recently uncovered differences in data capture between the STS Adult Cardiac Surgery Database and the Interagency Registry for Mechanically Assisted Circulatory Support Database. Unlike the current STS Adult Cardiac Surgery Database, the Interagency Registry for Mechanically Assisted Circulatory Support registry differentiates patients who are HIV+ from other immunocompromised patients and also includes HIV-specific variables, including CD4 count and viral load.…”

“…Unlike the current STS Adult Cardiac Surgery Database, the Interagency Registry for Mechanically Assisted Circulatory Support registry differentiates patients who are HIV+ from other immunocompromised patients and also includes HIV-specific variables, including CD4 count and viral load. Using this registry, Birk and colleagues 20 reviewed the impact of HIV infection on outcomes of left ventricular assist device support. Similar to our results, their data demonstrate that patients who were HIV+ were more likely to abuse tobacco and other polysubstances than uninfected patients.…”

“…HIV infection, similar to other chronic diseases like cirrhosis, syphilis, rheumatoid arthritis, systemic lupus erythematosus, for example, remain poorly accounted for when determining perioperative risk of heart surgery. The recently released STS Operative Risk Calculator Version 2.0.3 begins to include the risk of “liver disease” for patients with cirrhosis, similar to how patients with HIV may still be considered “immunocompromised.” Birk and colleagues 20 have well demonstrated that the inclusion of HIV-specific variables including a history of diagnosis, CD4 count, and viral load are sufficient to study perioperative risk assessment in the surgical management of heart failure. Our authors propose that similar inclusion of these 3 HIV-specific variables would be sufficient to derive true surgical risk of HIV infection in adult cardiac surgery.…”