Disclosures: The authors report no relevant financial disclosures.
September 08, 2021
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HIV infection associated with elevated risk for sudden cardiac death

Disclosures: The authors report no relevant financial disclosures.
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Compared with those without it, veterans with HIV had increased risk for sudden cardiac death, according to findings published in the Journal of the American Heart Association.

However, sudden cardiac death risk was not higher in people with HIV who had healthy levels of CD4 cells or low levels of HIV in their blood, according to the researchers.

Compared with those without it, veterans with HIV had increased risk for sudden cardiac death, according to findings published in the Journal of the American Heart Association.
Compared with those without it, veterans with HIV had increased risk for sudden cardiac death. Data were derived from Freiberg M, et al. J Am Heart Assoc.2021;doi:10.1161/JAHA.10.1161/JAHA.121.021268.

“People living with HIV have higher sudden cardiac death (SCD) rates compared to the general population. Whether HIV infection is an independent SCD risk factor is unclear,” Matthew S. Freiberg, MD, MSc, the Dorothy and Laurence Grossman Chair in Cardiology and professor of medicine at Vanderbilt University Medical Center, and colleagues wrote. “The objective of this study was to examine the association between HIV and SCD risk in a large national cohort of veterans with HIV and demographically and behaviorally similar veterans without HIV.”

In a national study, researchers observed 144,336 matched participants with and without HIV (30% with HIV; mean age at baseline, 50 years; 97% men; 47% Black) from the ongoing, long-term, national Veterans Aging Cohort Study. All participants were aged at least 18 years. Veterans attended a baseline clinical visit on or after April 1, 2003, and were followed until 2014 (median, 9 years). From baseline to 2014, 3,035 SCDs occurred, 26% in veterans with HIV.

Using Cox proportional-hazards regression, researchers determined whether HIV infection, CD4 cell counts and/or HIV viral load correlated with WHO-defined SCD risk.

Researchers found that HIV infection was linked to increased SCD risk (HR = 1.14; 95% CI, 1.04-1.25).

Time-varying CD4 and HIV viral load analyses showed that SCD risk was particularly increased in participants with HIV with CD4 counts less than 200 cells/mm3 (HR = 1.57; 95% CI, 1.28-1.92) and with HIV viral load greater than 500 copies/mL (HR = 1.7; 95% CI, 1.46-1.98). In contrast, people living with HIV with CD4 cell counts greater than 500 cells/mm3 (HR = 1.03; 95% CI, 0.9-1.18) or HIV viral load less than 500 copies/mL (HR = 0.97; 95% CI, 0.87-1.09) were not at increased SCD risk compared with participants without HIV.

The researchers concluded that treating HIV and the associated risk factors for SCD could reduce SCD among people with HIV.

Limitations of this study include lack of autopsy data and inexact causes of death.

Zian H. Tseng

“Addressing risk factors related to both cardiovascular disease and HIV is essential to prevent the higher rates of SCD in people with HIV,” Zian H. Tseng, MD, MAS, professor of medicine in residence, Murray Davis Endowed Professor at the University of California, San Francisco, said in a press release. “Clinicians should consider screening for specific warning signs of SCD such as fainting or heart palpitations. And, if indicated, clinicians should request additional testing such as echocardiograms or continuous rhythm monitoring.”