Patients with HIV may face a higher risk of sudden cardiac death (SCD) than persons without HIV when the virus is not suppressed or CD4 cell counts are low, suggests a new analysis published in the Journal of the American Heart Association.
“People living with HIV are already known to have a higher risk of heart attack, stroke, heart failure, blood clots in the lungs and peripheral artery disease,” said lead author Matthew Freiberg, MD, MSc, professor of medicine, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, in an American Heart Association press release.
“We know that among people with HIV, those who have a compromised immune system, for example a low total CD4+ T cell count, they seem to have a higher risk of cardiovascular disease than those who have high CD4+ T cell counts,” added Freiberg. “It is unclear if a compromised immune system is a risk factor for sudden cardiac death.”
To our knowledge, this is the largest study to date reporting that people living with HIV (PLWH) have an excess risk of SCD and the only national study to compare PLWH with a demographically and behaviorally (eg, substance use and abuse) similar uninfected reference population that included adjudicated SCDs.
Freiberg and colleagues aimed to examine the rate of SCD (defined for the purpose of the study using World Health Organization criteria) on a national scale, along with the influence of HIV viral loads and other cardiovascular disease (CVD) risk factors on the risk of SCD.
Researchers analyzed data from 144 335 participants (30% with HIV; median age, 50 years; 97% men; 47% Black) from the Veterans Aging Cohort Study (VASC). VASC is an ongoing national study of veterans with and without HIV matched 1:2 on age, sex, race/ethnicity, and clinical site.
Participants attended a baseline clinical visit on or after April 1, 2003 and were followed until December 31, 2014. During a median follow-up of 9 years, 3035 SCDs occurred, with 777 (26%) in veterans with HIV.
After adjusting for possible confounders (eg, CVD, renal disease, alcohol or cocaine dependence or abuse, smoking) researchers found veterans with HIV had a 14% increase in SCD risk compared with those without HIV. This risk was 29% higher among participants with HIV who had baseline CD4 cell counts <200 cells/mm3, and 17% higher among veterans with HIV with a baseline HIV viral load ≥500 copies/mL, both compared with those without HIV.
In analyses with time‐varying CD4 cell counts and viral load, CD4 cell counts <200 cells/mm3 in participants with HIV was associated with a 57% (HR, 1.57; 95% CI, 1.28-1.92) increased risk of SCD compared with those without HIV. Also, viral loads >500 copies/mL among veterans with HIV was associated with a 70% (HR, 1.70; 95% CI, 1.46-1.98) increased risk of SCD vs those without HIV.
On the other hand, participants with HIV and CD4 cell counts >500 cells/mm3 (HR, 1.03; 95% CI, 0.90-1.18) or HIV viral load <500 copies/mL (HR, 0.97; 95% CI, 0.871.09) were not at increased SCD risk, according to the study.
“In addition to HIV and cardiovascular risk factors, it is important for health care professionals to screen for and treat substance use disorders especially in people with HIV because they have a three times higher rate of overdose deaths presenting as cardiac arrest in our previous research,” said senior author Zian Tseng, MD, MAS, professor of medicine in residence, Murray Davis Endowed Professor, University of California, San Francisco in the press release.
Reference: Freiberg MS, Duncan MS, Alcorn C, et al. HIV infection and the risk of World Health Organization-defined sudden cardiac death. J Am Heart Assoc. Published online ahead of print. doi.org/10.1161/JAHA.121.021268