Risk of Heart Failure Doubled in People Living with HIV

According to the results of a new study, people living with HIV are twice as likely to develop cardiovascular disease than noninfected individuals. Furthermore, they are more likely to have incident heart failure than the general population, even after adjustment for demographics and cardiovascular risk factors.

The study investigators analyzed 4640 people living with HIV and 4650 uninfected controls receiving care at Northwestern Medicine from January 1, 2000, to July 12, 2016. Physicians reviewed patient data from available medical records to identify heart failure diagnoses. Follow up was carried out until incident heart failure, death, or, the most recent clinical encounter through July 12, 2016, for people without incident heart failure or death.

At baseline, 33.7% of people with HIV were taking antiretroviral therapy, and the first measured viral load was undetectable for 53.5%. The overwhelming majority (87.2%) used antiretroviral therapy during follow-up, and 48.3% used a protease inhibitor during follow-up.

Of the studied people living with HIV, 886 screened as having possible heart failure, of which 97 were determined to have incident heart failure. Meanwhile, 775 of the uninfected controls screened as having possible heart failure, of which 55 were determined to have incident heart failure.

A multivariable-adjusted analysis determined that people living with HIV were more than 2 times more likely to have incident heart failure than the controls, even after adjustment for age, sex, race/ethnicity, baseline body mass index, hypertension, diabetes, year of study entry, and coronary heart disease.

Looking at subpopulations within the HIV cohort, the researchers observed that higher viral load was associated with a significantly greater incidence of heart failure and higher CD4+ T cell count was associated with a significantly lower incidence of heart failure.

As patients adhering to antiretroviral therapy typically have lower viral loads and higher CD4+ T cell counts, “this illustrates the public health importance of prompt HIV diagnosis, early antiretroviral therapy initiation, and strict antiretroviral therapy adherence in this population,” explained the investigators.

However, they noted, heart failure risk was still heightened in those with low or undetectable loads and with CD4 counts ≥500 cells/mm³, suggesting that HIV-related viremia and immune dysfunction may cause HIV-associated heart failure. They added that inflammation and immune activation are hallmarks of HIV infection, even in the absence of peripherally detectable viremia, and also factors in heart failure among the general population.

An earlier version of this article was published as, “People Living With HIV Have 2-Fold Risk of Heart Failure,” on AJMC.com.