Perspective

HIV status significantly influences heart failure outcomes in women

Through an examination of data from a large U.S. health care system–based cohort, heart failure outcomes were found to differ significantly among women depending on their HIV status.

Among women with heart failure (HF), those living with HIV had higher rates of HF hospitalization, longer HF hospitalization stays and higher rates of all-cause and cardiovascular (CV) mortality, Sumbal A. Janjua, MD, from the division of cardiology and the department of radiology at Massachusetts General Hospital, and colleagues wrote in a research letter to the Journal of the American College of Cardiology.

Researchers used ICD-9 codes to identify a cohort of women (mean age, 59 years) with HF to evaluate differences in HF outcomes among those with and without HIV. During a median 9-year follow-up period, 34 of the 1,388 women who were identified as living with HIV had an initial diagnosis of HF (2.5% cumulative incident rate; 0.27% incident rate per year) vs. 102 of the 13,781 women in the control group without HIV (0.74% cumulative incident rate; 0.07% incident rate per year).

Starting from the initial diagnosis of HF, median follow-up was 5 years for women without HIV, 4 years for women with HIV. The primary outcome was HF hospitalization.

Women with HF living with HIV had higher rates of HF hospitalization (42 per 100 person-years) vs. women with HF and without HIV (9 per 100 person-years; P < .0001), Janjua and colleagues wrote.

The length of stay for HF hospitalization was 8 days for women with HF and HIV vs. 5 days for women without HIV (P < .0001). All-cause mortality was 53% in women with HF and HIV vs. 21% in women without HIV (P < .001). CV mortality was 83% in women with HF and HIV vs. 33% in women without HIV (P < .006).

In a multivariate analysis, living with HIV conferred greater risk for incident HF hospitalization (HR = 2.58; 95% CI, 1.55-4.29), according to the researchers.

Among those with HF with reduced ejection fraction, women with HIV were less likely to have optimal HF pharmacological therapy (40% vs. 83%; P = .01), Janjua and colleagues wrote.

“To our knowledge, this study is the first to report HF outcome differences among women with and without HIV. In this era of effective ART, understanding how HIV status influences the development of HF and HF outcomes in women is of critical public health importance to the 14 million women aging with HIV worldwide,” the researchers wrote. – by Suzanne Reist and Erik Swain

Disclosure: The researchers report no relevant financial disclosures.

Through an examination of data from a large U.S. health care system–based cohort, heart failure outcomes were found to differ significantly among women depending on their HIV status.

Among women with heart failure (HF), those living with HIV had higher rates of HF hospitalization, longer HF hospitalization stays and higher rates of all-cause and cardiovascular (CV) mortality, Sumbal A. Janjua, MD, from the division of cardiology and the department of radiology at Massachusetts General Hospital, and colleagues wrote in a research letter to the Journal of the American College of Cardiology.

Researchers used ICD-9 codes to identify a cohort of women (mean age, 59 years) with HF to evaluate differences in HF outcomes among those with and without HIV. During a median 9-year follow-up period, 34 of the 1,388 women who were identified as living with HIV had an initial diagnosis of HF (2.5% cumulative incident rate; 0.27% incident rate per year) vs. 102 of the 13,781 women in the control group without HIV (0.74% cumulative incident rate; 0.07% incident rate per year).

Starting from the initial diagnosis of HF, median follow-up was 5 years for women without HIV, 4 years for women with HIV. The primary outcome was HF hospitalization.

Women with HF living with HIV had higher rates of HF hospitalization (42 per 100 person-years) vs. women with HF and without HIV (9 per 100 person-years; P < .0001), Janjua and colleagues wrote.

The length of stay for HF hospitalization was 8 days for women with HF and HIV vs. 5 days for women without HIV (P < .0001). All-cause mortality was 53% in women with HF and HIV vs. 21% in women without HIV (P < .001). CV mortality was 83% in women with HF and HIV vs. 33% in women without HIV (P < .006).

In a multivariate analysis, living with HIV conferred greater risk for incident HF hospitalization (HR = 2.58; 95% CI, 1.55-4.29), according to the researchers.

Among those with HF with reduced ejection fraction, women with HIV were less likely to have optimal HF pharmacological therapy (40% vs. 83%; P = .01), Janjua and colleagues wrote.

“To our knowledge, this study is the first to report HF outcome differences among women with and without HIV. In this era of effective ART, understanding how HIV status influences the development of HF and HF outcomes in women is of critical public health importance to the 14 million women aging with HIV worldwide,” the researchers wrote. – by Suzanne Reist and Erik Swain

Disclosure: The researchers report no relevant financial disclosures.

    Perspective
    Priscilla Hsue

    Priscilla Hsue

    The findings of this study, which show that HF outcomes differ according to HIV status among women, are provocative, but not definitive, given the limited sample size of 34 women with HIV at the beginning of the study and six women with HIV at the end of the study.

    The findings add additional evidence that CV outcomes and mortality differ in HIV compared with the general population. However, the underlying reasons surrounding excess CV risk and outcomes in HIV remain uncertain. Taken as a whole, we as clinicians need to look deeper to ascertain why this is occurring. Is it disparities in health care, HIVspecific issues such as chronic inflammation/immune activation, illicit drug use, differences in CV treatment in the setting of HIV, or something else? Understanding the reasons why there are these findings will help us determine ways to best identify individuals living with HIV at risk for cardiovascular disease and how to best treat them.

    • Priscilla Hsue, MD
    • Professor of medicine University of California, San Francisco Cardiologist, Zuckerberg San Francisco General

    Disclosures: Hsue reports receiving honoraria from Gilead Sciences and research support from the NIH and Pfizer.