Meeting News

Rate of sudden arrhythmic death higher in patients with HIV

SEATTLE — The adjusted rate of sudden arrhythmic death is 53% higher in patients infected with HIV compared with uninfected patients, and higher levels of cardiac fibrosis could explain why, according to study findings presented at CROI.

Zian H. Tseng, MD, a cardiologist and electrophysiologist at University of California San Francisco Medical Center, and colleagues previously reported on the risk for presumed sudden cardiac death in patients with HIV. In the current study, the adjusted rate was 86% higher than in uninfected patients. However, they said, the incidence of sudden arrhythmic deaths in patients with HIV is unknown.

“The way we define sudden cardiac deaths are essentially presumed cardiac deaths. We can look at death certificates, we can look at paramedic run sheets, but it’s still the best guess of the paramedic or the clinician who last saw them,” Tseng said during a news conference at CROI. “So, we looked at it from a very simple question: How many of these sudden cardiac deaths are actually autopsy confirmed?”

Tseng and colleagues sought to determine the incidence of actual sudden arrhythmic deaths in people infected with HIV by prospectively identifying all incident deaths attributable to out-of-hospital cardiac arrest among individuals with and without HIV between 2011 to 2016 in San Francisco County.

According to the study, Tseng and colleagues identified 610 out-of-hospital deaths in people with HIV, of which 109 were called cardiac arrest by paramedics, and 47 of these met traditional sudden cardiac death criteria. According to Tseng, among the HIV-positive population there was an 86% higher rate of apparent sudden deaths, and after autopsy, the rate of sudden arrhythmic death was 58% higher. Overall, noncardiac causes accounted for more than half of the deaths, and of that half, most were overdoses.

“We found a surprising level of fibrosis, collagen tissue deposited in between the fibers of the myocardium,” he said. “That rate was 70% higher in HIV hearts. That could be the mechanism for how HIV increases risk for fatal arrythmias.”
A second study, presented by Matthew Freiberg, MD, professor of cardiovascular medicine at Vanderbilt University Medical Center, examined the association between HIV infection and sudden cardiac death in a large national cohort of HIV-infected and -uninfected veterans.

“We wanted to understand from an epidemiologic standpoint if HIV-infected people were at increased risk for sudden cardiac death,” Freiberg said. “We know from existing studies that there’s an increased risk of heart attack, stroke, heart failure. Sudden cardiac death is a really difficult outcome to define. They don’t often get autopsies, and they’re not readily available. So, we worked with Dr. Tseng’s group to try and understand from an epidemiologic standpoint.”

Freiberg and colleagues analyzed data on 144,362 veterans, 30% of whom were HIV positive, from the Veterans Aging Cohort Study, a prospective study of HIV-positive veterans. For the study, sudden cardiac death was determined using death certificates and a manual review of electronic health records throughout the year of death. According to the study, results showed that HIV-positive veterans had a 14% higher risk for sudden cardiac death (HR = 1.14; 95% CI, 1.04-1.25) compared with uninfected veterans. The risk was highest among those with sustained high HIV viral loads or low CD4 cell counts, the researchers said.

“I want to make it clear, because you remain virally suppressed does not mean that you never get sudden cardiac death. It is a relative risk phenom. We’re comparing to uninfected people,” Freiberg said. – by Caitlyn Stulpin

References:

Freiberg M, et al. Abstract 33. Presented at: Conference on Retroviruses and Opportunistic Infections; March 4-7, 2019; Seattle.

Tseng Z, et al. Abstract 32. Presented at: Conference on Retroviruses and Opportunistic Infections; March 4-7, 2019; Seattle.

Disclosures: Freiberg and Tseng report no relevant financial disclosures.

SEATTLE — The adjusted rate of sudden arrhythmic death is 53% higher in patients infected with HIV compared with uninfected patients, and higher levels of cardiac fibrosis could explain why, according to study findings presented at CROI.

Zian H. Tseng, MD, a cardiologist and electrophysiologist at University of California San Francisco Medical Center, and colleagues previously reported on the risk for presumed sudden cardiac death in patients with HIV. In the current study, the adjusted rate was 86% higher than in uninfected patients. However, they said, the incidence of sudden arrhythmic deaths in patients with HIV is unknown.

“The way we define sudden cardiac deaths are essentially presumed cardiac deaths. We can look at death certificates, we can look at paramedic run sheets, but it’s still the best guess of the paramedic or the clinician who last saw them,” Tseng said during a news conference at CROI. “So, we looked at it from a very simple question: How many of these sudden cardiac deaths are actually autopsy confirmed?”

Tseng and colleagues sought to determine the incidence of actual sudden arrhythmic deaths in people infected with HIV by prospectively identifying all incident deaths attributable to out-of-hospital cardiac arrest among individuals with and without HIV between 2011 to 2016 in San Francisco County.

According to the study, Tseng and colleagues identified 610 out-of-hospital deaths in people with HIV, of which 109 were called cardiac arrest by paramedics, and 47 of these met traditional sudden cardiac death criteria. According to Tseng, among the HIV-positive population there was an 86% higher rate of apparent sudden deaths, and after autopsy, the rate of sudden arrhythmic death was 58% higher. Overall, noncardiac causes accounted for more than half of the deaths, and of that half, most were overdoses.

“We found a surprising level of fibrosis, collagen tissue deposited in between the fibers of the myocardium,” he said. “That rate was 70% higher in HIV hearts. That could be the mechanism for how HIV increases risk for fatal arrythmias.”
A second study, presented by Matthew Freiberg, MD, professor of cardiovascular medicine at Vanderbilt University Medical Center, examined the association between HIV infection and sudden cardiac death in a large national cohort of HIV-infected and -uninfected veterans.

“We wanted to understand from an epidemiologic standpoint if HIV-infected people were at increased risk for sudden cardiac death,” Freiberg said. “We know from existing studies that there’s an increased risk of heart attack, stroke, heart failure. Sudden cardiac death is a really difficult outcome to define. They don’t often get autopsies, and they’re not readily available. So, we worked with Dr. Tseng’s group to try and understand from an epidemiologic standpoint.”

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Freiberg and colleagues analyzed data on 144,362 veterans, 30% of whom were HIV positive, from the Veterans Aging Cohort Study, a prospective study of HIV-positive veterans. For the study, sudden cardiac death was determined using death certificates and a manual review of electronic health records throughout the year of death. According to the study, results showed that HIV-positive veterans had a 14% higher risk for sudden cardiac death (HR = 1.14; 95% CI, 1.04-1.25) compared with uninfected veterans. The risk was highest among those with sustained high HIV viral loads or low CD4 cell counts, the researchers said.

“I want to make it clear, because you remain virally suppressed does not mean that you never get sudden cardiac death. It is a relative risk phenom. We’re comparing to uninfected people,” Freiberg said. – by Caitlyn Stulpin

References:

Freiberg M, et al. Abstract 33. Presented at: Conference on Retroviruses and Opportunistic Infections; March 4-7, 2019; Seattle.

Tseng Z, et al. Abstract 32. Presented at: Conference on Retroviruses and Opportunistic Infections; March 4-7, 2019; Seattle.

Disclosures: Freiberg and Tseng report no relevant financial disclosures.

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