Heart failure and adverse heart failure outcomes among persons living with HIV in a US tertiary medical center

Alvi, Raza M.; Afshar, Maryam; Neilan, Anne M.; Tariq, Noor; Hassan, Mahad M.; Gerber, Jaime; Awadalla, Magid; Mulligan, Connor P.; Rokicki, Adam; Triant, Virginia A.; Zanni, Markella V.; Neilan, Tomas G.

doi:10.1016/j.ahj.2019.01.002

Cited by 26 publications

(14 citation statements)

References 33 publications

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“…Our study extends previous single-centre studies and others that focused only on selected HF patients. 17 The adjusted risks of death being higher among PLWH with low CD4 count (<500 cells/μL), supports the hypothesis that the excess risks of these outcomes were unlikely directly HF-related given that low CD4 count was not independently associated with a higher risk of HF hospitalizations or HF-related ED visits, and PLWH having low CD4 count are known to be at higher risk for premature death due to non-cardiovascular causes. 35 In PLWH with severe immune deficiency, viruses may induce inflammatory damage, apoptosis, and mitochondrial dysfunction in myocardial cells.…”

Section: Discussionsupporting

confidence: 60%

“…Studies of women and predominantly Black or Hispanic adults hospitalized for HF have reported higher risks of recurrent HF hospitalization, cardiovascular death, and death in PLWH. 16 , 17 Short-term risk of adverse HF outcomes among PLWH after hospitalization for HF has also been reported to be associated with an individual’s level of immunodeficiency or ART regimen. 17 , 18 These findings, however, are not generalizable to the contemporary incident HF population among PLWH and have been largely derived from single-centre investigations of only hospitalized adults with HF, with relatively short follow-up and limited patient diversity.…”

Section: Introductionmentioning

confidence: 99%

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

Avula

Ambrosy

Silverberg

et al. 2021

European Heart Journal Open

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Aims Human immunodeficiency virus (HIV) increases the risk of heart failure (HF), but whether it influences 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 U.S. integrated healthcare delivery systems. We estimated incidence rates and adjusted hazard ratios by HIV status at the time of HF diagnosis for subsequent outcomes. We identified 448 persons living with HIV (PLWH) and 3,429 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 (adjusted hazard ratio [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. Conclusions In a large, diverse cohort of adults with incident HF receiving care within an 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.

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Section: Discussionsupporting

confidence: 60%

Section: Introductionmentioning

confidence: 99%

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

Avula

Ambrosy

Silverberg

et al. 2021

European Heart Journal Open

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“…Animal experiments have shown that excessive lipids in cardiomyocytes can produce lipotoxic intermediates, cause cell apoptosis, and lead to the occurrence of HF. In addition, ART may be related to the increased risk of cardiovascular disease (Alvi et al, 2019), but the research on the relationship between ART and HF development is limited, and further research is needed.…”

Section: Discussionmentioning

confidence: 99%

HIV infection and risk of heart failure: A meta-analysis and systematic review

Li¹

2022

Acta Biochim Pol

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Background: Heart failure (HF) is commonly seen in patients with human immunodeficiency virus (HIV) infection. We aimed to evaluate the potential correlations of HIV infection and risk of HF, to provide evidence to the management of HIV and HF. Methods: We searched PubMed and other databases to identify prospective cohort studies on the risk of HIV infection and heart failure, we used Stata 13 software for Meta-analysis, and we calculated the hazard ratio (HR) values and 95% confidence interval (CI) values for the risks of HF in patients with and without HIV infections. Results: A total of five studies were included, with 8457 cases in the HIV-infection and 21917 cases in the non-HIV-infection group. Meta-analysis results showed that HIV infection can increase the risk of HF by 48% (HR=1.48, 95% CI1.31~1.67). Subgroups analyses by HIV-1 RNA viral load, CD4+ cell count, and study population also favored the overall results, and the research heterogeneity mainly come from the group of veterans in the research population. Conclusions: HIV infection is one of the risk factors for HF, which can increase the risk of heart failure, early preventions and interventions are needed for those populations.

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“…The cumulative viral load means a person had a detectable viral load for progressively longer times, inducing chronic inflammation. Epidemiologic studies suggest that keeping viral load consistently undetectable with cART reduces the risk of a cardiovascular event [48,49]. For instance, in the SMART study, cART interruption was associated with increased CVD, mainly as consequence of lowering CD4+ cell count and increasing viral load [50].…”

Section: Discussionmentioning

confidence: 99%

Factors Associated with Incident Cardiovascular Events and Cardiac Risk Assessment in a Cohort of HIV-infected Participants in Rio de Janeiro

Moreira¹,

Miranda²,

Müller³

et al. 2021

IJIDT

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Background: Cardiovascular events (CVEs) have emerged as an important cause of morbimortality in people living with HIV/AIDS (PLHA). We aimed to investigate factors associated with incident CVE and compare the observed incidence with the predicted CVE risk by three different equations. Methods: Among the 649 active participants of the INI-ELSA cohort, we analysed data of 644 individuals free of CVE at baseline examinations. We used Cox regression models to study factors associated with CVE and to assess the equation's performance we compared the observed incidence with the overall 5-year predicted risks. Results: Over a median follow-up of 6.26-years (interquartile range [IQR] 6.01-6.47), there were 18 CVE, four deaths. Overall, 57.92% were male, median age was 43.4 years (35.82-50.73), most were on cART (88.65%). Participants who had CVE were older, had poorer renal function, higher proportion of dyslipidemia and higher levels of systolic blood pressure and triglycerides. The observed CVE rate was 2.90% (1.60-4.90%) whereas their overall cardiovascular disease (CVD) risk differed depending on which score was used: 0.91 (0.42-20), 1.16 (0.38-2.78) and 1.68 (0.60-3.87), according to Framingham, ASCVD and DAD, respectively. In the multivariable Cox analysis black race, smoking 10+ packs years, dyslipidemia, current CD4 cell count x10 1 , cumulative viral load and time on NNRTI were independent predictors of CVE. Conclusion: Both traditional and HIV-related factors were associated with incident CVE. Risk scores were inconsistent in classifying patients who had CVE as high risk, indicating that validation studies are required to improve risk assessment of PLHA in Brazil.

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Heart failure and adverse heart failure outcomes among persons living with HIV in a US tertiary medical center

Cited by 26 publications

References 33 publications

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

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

HIV infection and risk of heart failure: A meta-analysis and systematic review

Factors Associated with Incident Cardiovascular Events and Cardiac Risk Assessment in a Cohort of HIV-infected Participants in Rio de Janeiro

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