 |
|
|
| |
Sudden cardiac death risk higher with HIV--but not with sustained HIV control / "Sudden cardiac death among HIV-infected and -uninfected veterans"
|
| |
| |
Conference on Retroviruses and Opportunistic Infections (CROI), March 4-7, 2019, Seattle
Mark Mascolini
WEBCAST: http://www.croiwebcasts.org/console/player/41071?mediaType=slideVideo&&crd_fl=0&ssmsrq=1554044502926&ctms=5000&csmsrq=5091
Veterans with HIV had a 15% higher risk of sudden cardiac death than their HIV-negative counterparts in a 144,000-person comparison [1]. Risk proved even higher in veterans with sustained high viral load or low CD4 count, but risk disappeared in those with durable HIV control.
Research confirms heightened HIV-related risk of acute myocardial infarction, ischemic stroke, peripheral arterial disease, and other cardiovascular diseases, noted Veterans Aging Cohort Study (VACS) researchers who conducted the new analysis. But whether people with HIV suffer sudden cardiac death more often than people without HIV remains unclear. The VACS researchers believe the most definitive study involved 2860 HIV-positive people in San Francisco [2]. That study found a 4.5-fold higher rate of sudden cardiac death than expected in the local population.
The new analysis involved 144,362 VACS participants, almost one third of them with HIV. Follow-up ran from April 2003 until sudden cardiac death, any death, last follow-up date, or December 2014. The researchers identified sudden cardiac death with an algorithm incorporating death certificates, administrative data, and manual review of Veterans Affairs electronic health records. This analysis did not include autopsy data.
The 43,413 VACS participants with HIV were a little younger than the 100,949 without HIV (average 49.2 vs 50.2 years). Proportions of blacks (about 47%) and whites (about 40%) were similar in the two groups, as were proportions of men (97% in both groups). A higher proportion of the HIV group currently smoked (55% vs 49%), and a higher proportion had HCV infection (28.9% vs 13.6%), but a lower proportion had a history of cardiovascular disease (13.6% versus 17.7%). Among veterans with HIV, median viral load stood at 999 copies and median CD4 count at 385.
A model adjusted for age, sex, race, prevalent cardiovascular disease, and numerous other cardiovascular risk factors determined that veterans with HIV had a 15% higher risk of sudden cardiac death (hazard ratio [HR] 1.15, 95% confidence interval [CI] 1.05 to 1.26). Compared with HIV-negative veterans, those with HIV had a progressively higher risk with lower CD4 counts (200 to 500 CD4s, HR 1.12, 95% CI 0.99 to 1.28; under 200 CD4s, HR 1.30, 95% CI 1.10 to 1.54). Compared with HIV-negative participants, sudden cardiac death risk was moderately higher with a viral load above 500 copies (HR 1.17, 95% CI 1.04 to 1.32) than below 500 copies (HR 1.13, 95% CI 1.00 to 1.26).
In models adjusted for the same variables but with time-updated CD4 count and viral load, HIV conferred a significantly higher risk of sudden cardiac death only at a CD4 count below 200 (HR 1.57, 95% CI 1.29 to 1.92) and a viral load above 500 copies (HR 1.70, 95% CI 1.46 to 1.98).
Among veterans with HIV, factors independently linked to sudden cardiac death were every 10 years of age (HR 1.38), male sex (HR 2.04), prevalent cardiovascular disease (HR 1.88), controlled hypertension (HR 1.45), current versus never smoking (HR 1.62), HCV infection (HR 1.40), every 5 kg/m2 higher body mass index (HR 1.10), anemia (HR 1.35), alcohol use disorder (HR 1.43), and chronic obstructive pulmonary disease (HR 1.24).
The researchers stressed that the overall 15% excess risk of sudden cardiac death with HIV jumped to 57% in those with a CD4 count below 200 and to 70% in those with a viral load above 500 copies. But excess risk of sudden cardiac death vanished in veterans with sustained viral load suppression or high CD4 count.
References
1. Freiberg MS, Duncan MS, Kundu S, et al. Sudden cardiac death among HIV-infected and -uninfected veterans. Conference on Retroviruses and Opportunistic Infections (CROI). March 4-7, 2019. Seattle. Abstract 32.
2. Tseng ZH, Secemsky EA, Dowdy D, et al. Sudden cardiac death in patients with human immunodeficiency virus infection. J Am Coll Cardiol. 2012;59:1891-1896. https://www.sciencedirect.com/science/article/pii/S0735109712009412?via%3Dihub
|
| |
|
|
|
|
|
