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Age, Sex Factors for Heart Failure Among HIV Patients

Providers of patients with HIV should have greater sensitivity to symptoms of heart failure, the study authors suggested.

People with HIV are at higher risk for developing heart failure, but especially those younger than 40 years of age, women, and those of Asian or Pacific Islander heritage, according to a paper published in Mayo Clinic Proceedings.

Investigators from Kaiser Permanente retrospectively analyzed cohort studies of more than 38,000 persons with HIV (PWHs) in order to evaluate the risk of heart failure linked to HIV and determine how the risk varies based on demographic characteristics. Each of the PWHs matched with 10 people without HIV based on age, sex, race/ethnicity, and treating facility in studies than ran from 2000 to 2016. The investigators identified newly diagnosed heart failure based on a primary hospital discharge diagnosis or having 3 or more outpatient visits coded for heart failure with 1 or more visit to a cardiologist, they explained.

The median participant age was 41 years, the investigators noted, and 12 percent were women. In terms of race/ethnicity, the study authors said that 21 percent of participants were Black, 20 percent were Hispanic, and nearly 4 percent were Asian/Pacific Islander. The authors also observed that PWHs were more likely to have liver disease, depression, proteinuria, and previous illicit drug use or alcohol abuse compared to adults without HIV. PWHs were additionally less likely than adults without HIV to have known cardiovascular or metabolic conditions, the study authors said, including atrial fibrillation, coronary revascularization, valvular disease, hypertension, diabetes, and dyslipidemia.

When the study authors looked at demographic subgroups, they found that in terms of age, there was a stronger association of positive HIV status with incident heart failure among younger aged adults. For example, PWHs aged 21 to 40 had a nearly 2.5-fold increase of incident heart failure compared to those without HIV, where heart failure was stronger in those aged 41 to 50 years and those aged 51 and older. PWHs additionally had a stronger association with incident heart failure in women than in men, the study authors observed.

Finally, the study authors noted, PWHs had an increased adjusted rate of incident heart failure in White, Black, and Asian/Pacific Islander adults, but not as much in Hispanic adults. They said there was no observed significant interactions between HIV status and race/ethnicity.

“Our study highlights why physicians should be aware of the higher risk of heart failure in people with HIV,” Alan S. Go, MD, senior research scientist at the Kaiser Permanente Division of Research and Michael J. Silverberg, PhD, MPH, research scientist and HIV epidemiologist at the Kaiser Permanente Division of Research told Contagion. “Physicians of patients with HIV should also have a greater sensitivity to symptoms that may reflect new heart failure so that a diagnostic workup can be expedited.”

“Physicians should be aware that while all people with HIV are at higher risk of developing heart failure, the excess risk appears to be more prominent in those younger than 40, women, and those of Asian or Pacific Islander heritage,” they continued. “For all people with HIV, physicians should implement a comprehensive approach that recommends healthy diet choices, greater physical activity, stopping tobacco use, avoiding drugs and other substances, and appropriate use of preventive medications to address clinical cardiovascular risk factors and optimize heart health