Author + information
- Received April 12, 2019
- Accepted April 29, 2019
- Published online August 7, 2019.
- Raza M. Alvi, MDa,b,
- Anne M. Neilan, MD, MPHc,
- Noor Tariq, MDd,
- Malek O. Hassan, MDa,
- Magid Awadalla, MDa,
- Lili Zhang, MD, ScMa,
- Maryam Afshar, MDb,
- Adam Rokicki, BSa,
- Connor P. Mulligan, BAa,
- Virginia A. Triant, MD, MPHe,
- Markella V. Zanni, MDf and
- Tomas G. Neilan, MD, MPHa,∗ ()
- aCardiac MR PET CT Program, Department of Radiology and Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
- bBronx-Lebanon Hospital Center of Icahn School of Medicine at Mount Sinai, Bronx, New York
- cDivision of Infectious Diseases, Department of Medicine and Department of Pediatrics, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
- dYale New Haven Hospital of Yale University School of Medicine, New Haven, Connecticut
- eDivisions of Infectious Diseases and General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
- fProgram in Nutritional Metabolism, Harvard Medical School, Boston, Massachusetts
- ↵∗Address for correspondence:
Dr. Tomas G. Neilan, Cardiac MR PET CT Program, Massachusetts General Hospital, 165 Cambridge Street, Suite 400, Boston, Massachusetts 02114.
Objectives The aim of this study was to determine the incidence of sudden cardiac death (SCD) among persons living with human immunodeficiency virus infection (PHIV) with heart failure (HF), who were hospitalized for HF, and the risk factors associated with it.
Background HF is associated with an increased risk for SCD. PHIV are at heightened risk for HF.
Methods This was a retrospective study of 2,578 patients hospitalized with HF from a single academic center, of whom 344 were PHIV. The outcome of interest was SCD. Subgroup analyses were performed by strata of viral load (VL) and left ventricular ejection fraction (LVEF) <35%, 35% to 49%, and ≥50%.
Results Of 2,578 patients with HF, 2,149 (86%) did not have implantable cardioverter-defibrillators; of these, there were 344 PHIV and 1,805 uninfected control subjects. Among PHIV with HF, 313 (91%) were prescribed antiretroviral therapy and 64% were virally suppressed. There were 191 SCDs over a median follow-up period of 19 months. Compared with control subjects, PHIV had a 3-fold increase in SCD (21.0% vs. 6.4%; adjusted odds ratio: 3.0; 95% confidence interval: 1.78 to 4.24). Among PHIV, cocaine use, lower LVEF, absence of beta-blocker prescription, and VL were predictors of SCD. The SCD rate among PHIV with undetectable VL was similar to the rate among uninfected subjects. Similar findings were observed by LVEF strata. Among PHIV with HF without conventional indications for an implantable cardioverter-defibrillator, the rate of SCD was 10% per year.
Conclusions PHIV hospitalized with HF are at a markedly increased risk for SCD. SCD risk was increased in patients with lower LVEFs, lower CD4 counts, and higher VL.
This work was supported by the National Heart, Lung, and Blood Institute (grant 5T32HL076136 to Dr. Alvi, grant 1R01HL137562-01A1 to Drs. Zanni and T.G. Neilan, grant 1R01HL132786-01A1 to Dr. Triant, and grants 1R01HL130539-01A1 and K24HL113128-06 to Dr. T.G. Neilan); A. Curtis Greer, JD; Pamela Kohlberg and the Kohlberg Foundation; an American Heart Association Fellow to Faculty Award (12FTF12060588 to Dr. Neilan); the Eunice Kennedy Shriver National Institute for Child Health and Human Development (grant K08HD094638 to Dr. A.M. Neilan); the National Institutes of Health/Harvard Center for AIDS Research (grant P30-AI060354 to Dr. A.M. Neilan, Zanni, and T.G. Neilan); an International Maternal Pediatric AIDS Clinical Trials Network Early Investigator Award (UM1AI068632 to Dr. A.M. Neilan); and the Nutrition Obesity Research Center at Harvard University (grant P30-DK040561 to Dr. Zanni). All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received April 12, 2019.
- Accepted April 29, 2019.
- 2019 American College of Cardiology Foundation
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