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HIV is Associated With Higher Risk of Atrial Fibrillation

SEP 19, 2019 | LAURIE SALOMAN, MS
It’s well known in the medical community that people with HIV have an elevated risk of certain cardiovascular conditions, such as coronary artery disease and heart failure. A new study demonstrates that a greater likelihood of atrial fibrillation (AFib), or abnormal heart rhythm, now can be added to the list of health issues experienced by people living with HIV. 

Investigators at the University of California, San Francisco (UCSF) examined the records of more than 17 million California residents who were first seen in emergency departments and inpatient or outpatient units from 2005 to 2011. The patients were followed for several years and investigators observed that the patients who had HIV were significantly more likely to develop AFib during that time period than those who did not have HIV. In fact, AFib diagnoses occurred at a rate of 18.2 per 1000 person-years in HIV-positive subjects vs. 8.9 per 1000 person-years in HIV-negative subjects. This determination was made after adjusting for factors including age, race, gender, and a host of comorbid conditions.

The study was not designed to specifically identify the origins of the HIV-AFib correlation, and it isn’t known whether subjects were taking antiretroviral therapy (ART), which could be a factor. So, what could account for the higher risk of AFib in people living with HIV?

“We know that inflammation, or aberrancies in the immune system, can lead to atrial fibrillation in some cases,” Gregory Marcus, MD, MAS, a cardiologist and professor of medicine at UCSF School of Medicine, and lead author of the study, told Contagion®. “There has been speculation that viral infections resulting in inflammation of the upper chambers of the heart (or the atria) could promote atrial fibrillation, but to my knowledge, this is the first study to demonstrate that a diagnosis of a specific type of viral infection significantly predicted incident atrial fibrillation.”

Notably, black, Latino, and younger patients with HIV—along with HIV-positive subjects who did not have hypertension or diabetes and did not abuse alcohol—had higher relative risks of developing AFib during the course of the study compared with white and older patients and those who had other diseases. As Marcus explained it, younger people and people of color normally have lower rates of AFib than the general population, making their disproportionately escalated risk with HIV significant. 

“[B]ecause their overall and absolute risk of atrial fibrillation is so low at baseline, they may not have experienced an overall/absolute higher rate of atrial fibrillation,” he said. “However, that statistically significant distinction suggests that the mechanism by which HIV increases atrial fibrillation risk is independent of common pathways for the disease, implying there is something specific about HIV (separate from established risk factors) that is operative.”

For clinicians who treat people with HIV, the study’s findings should prompt “heightened suspicion” of AFib when encountering complaints of palpitations, fatigue, or shortness of breath, Marcus said. Patients should be examined for arrhythmias and potentially sent for an electrocardiogram; however, not all patients necessarily will need to see a cardiologist.

According to the US Centers for Disease Control and Prevention, anywhere from 2.7% to 6.1% of people have AFib, with 2% of those under age 65 and 9% of those over 65 years afflicted. People with AFib are 4 to 5 times more likely to have a stroke due to the greater likelihood that irregular heart rhythms will result in blood clots. Deaths as a result of AFib have been on the upswing for at least 20 years.

Marcus’ team is conducting an ongoing study to improve heart health. Interested individuals can learn more here.
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