Atrial Fibrillation and Atrial Flutter in Human Immunodeficiency Virus-Infected Persons

Hsu, Jonathan C.; Li, Yongmei; Marcus, Gregory M.; Hsue, Priscilla Y.; Scherzer, Rebecca; Grünfeld, Carl; Shlipak, Michael G.

doi:10.1016/j.jacc.2013.03.022

Cited by 84 publications

(48 citation statements)

References 33 publications

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“…However, little is currently known about the relationship of HIV infection and AF. In a large study of veterans, the age-adjusted rates of AF found in HIV+ veterans were noticeably higher than the rates reported in several other cohort studies in the general population [37•]. As expected, this difference was even more striking in younger age groups.…”

Section: Cardiac Arrhythmiamentioning

confidence: 54%

“…In multivariable analyses, after adjusting for traditional risk factors, markers of HIV disease severity such as a lower CD4(+) cell count and higher viral load were associated with higher risk of AF. Other important risk factors for increased risk of AF included older age, Caucasian ethnicity, CAD, HF, alcoholism, proteinuria, renal dysfunction, and hypothyroidism [37•]. …”

Section: Cardiac Arrhythmiamentioning

confidence: 99%

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HIV Infection and Risk of Cardiovascular Diseases Beyond Coronary Artery Disease

Barnes

Lacson

Bahrami

2017

Curr Atheroscler Rep

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Purpose of Review Cardiovascular disease (CVD) increasingly afflicts people living with HIV (PLWH) in the contemporary era of antiretroviral therapy (ART). Coronary artery disease (CAD) is the most widely studied cardiovascular problem in PLWH; however, less is known about other clinically relevant subtypes of CVD such as heart failure (HF), cerebrovascular disease, sudden cardiac death, pericardial diseases, and pulmonary hypertension. This paper reviews evidence of other subtypes of CVD as emerging issues in the post-ART era. Recent Findings Recent studies have shown that PLWH have higher risk of HF as well as subclinical impairment of left ventricular (LV) mechanics (systolic and diastolic dysfunction) and myocardial abnormalities (fibrosis and steatosis). The underlying mechanisms, however, are not well-understood. A few studies have also shown higher rates of atrial fibrillation and sudden cardiac death in PLWH. Ischemic stroke is the most common stroke type in the post-ART era, with underlying mechanisms like those identified in CAD: chronic inflammation and associated vasculopathy. Studies of great vessels (carotid artery and aorta) and peripheral arterial disease show heterogeneous results. Small subclinical pericardial effusions are common in PLWH in post-ART era. Pulmonary hypertension continues to be an underdiagnosed and potentially fatal complication of HIV infection. Summary PLWH remain at higher risk for all types of CVD including heart failure, stroke, and arrhythmias in the post-ART era. Chronic inflammation may play an important role in this increased risk. More studies are needed to further elucidate the extent of non-coronary CVD in PLWH and the underlying mechanisms for them.

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Section: Cardiac Arrhythmiamentioning

confidence: 54%

Section: Cardiac Arrhythmiamentioning

confidence: 99%

HIV Infection and Risk of Cardiovascular Diseases Beyond Coronary Artery Disease

Barnes

Lacson

Bahrami

2017

Curr Atheroscler Rep

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“…5 Thus, it is possible that the CHA 2 DS 2 -VASc score was not significantly associated with TE events in the HIV population because it does not include HIV-specific factors, such as CD4 counts and viral load suppression, which are related to atrial fibrillation. 5 …”

Section: Discussionmentioning

confidence: 99%

CHA2DS2-VASc Score, Warfarin Use, and Risk for Thromboembolic Events Among HIV-Infected Persons With Atrial Fibrillation

Chau

Scherzer

Grünfeld

et al. 2017

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background The prevalence of atrial fibrillation in the human immunodeficiency virus (HIV)-infected population is growing, but the ability of the CHA2DS2-VASc score to predict thromboembolic (TE) risk is unknown in this population. Setting Within the Veterans Affairs HIV Clinical Case Registry, 914 patients had an atrial fibrillation diagnosis between 1997–2011 and no prior TE events. Methods We compared TE incidence by CHADS2VASc scores, and stratified by warfarin use. Using Cox proportional hazards regression with adjustment for competing risks, we modeled associations of CHADS2VASc scores and warfarin use with TE risk. Results At baseline, the distribution of CHA2DS2-VASc scores was 0 (n=208), 1 (n=285), and 2+ (n= 421); 34 patients developed 38 TE events during a median of 3.8 years follow-up. Event rates by CHA2DS2-VASc scores of 0, 1, and 2+ were 5.4, 9.3, and 8.1 per 1000 person years, respectively; multivariate adjusted hazards ratios (HRs) were 1.70 (95% confidence interval [CI] 0.65, 4.45) for CHA2DS2-VASc score 1 (p=0.28) and HR=1.34 (0.51, 3.48) for score 2+ versus 0 (p=0.55). Baseline warfarin use was associated with increased TE risk, though not statistically significant (HR 2.06 [0.86, 4.93], p=0.11) with similar results when modeled as time-updated use and duration of use. Conclusion In this national registry of HIV-infected veterans with atrial fibrillation, CHA2DS2-VASc scores were only weakly associated with TE risk. Furthermore, warfarin did not appear to be effective at preventing TE events. These results should raise concerns about the optimal strategy for TE prevention among HIV-infected persons with atrial fibrillation.

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“…In high-income countries, CVD is the second non-AIDS cause of death in people living with HIV infection, and it is a significant contributor to non-AIDS deaths in developing and sub-Saharan countries [5–7]. Studies have shown that HIV-infected individuals are at higher risk of several cardiovascular abnormalities, such as coronary artery disease (CAD) [8, 9], heart failure and heart failure admission [10], subclinical atherosclerosis of coronary [11–13] and carotid arteries [8, 14, 15], global and regional left ventricular (LV) systolic function [16], LV diastolic dysfunction [16, 17], myocardial fibrosis and steatosis [9, 18], pulmonary hypertension [19], stroke [20], atrial fibrillation [21], and sudden cardiac death [22]. However, the mechanisms contributing to these increased risks are not well understood.…”

Section: Introductionmentioning

confidence: 99%

Coronary Artery Disease in HIV-Infected Patients: Downside of Living Longer

Lacson

Barnes

Bahrami

2017

Curr Atheroscler Rep

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Purpose of Review Introduction of combination antiretroviral therapy (ART) has increased the life expectancy of patients with HIV infection, allowing them to live longer with this chronic medical condition and consequently experiencing conditions such as cardiovascular diseases (CVDs). Several studies have investigated the increased risk of CVD in people living with HIV (PLWH). However, less is known about the exact mechanisms involved in this increased risk. Also, specific guidelines for management of CVD in PLWH have not been developed yet. In this article, we review the recent literature on the mechanisms involved in pathogenesis of CVD in PLWH, with an emphasis on coronary artery disease (CAD). Recent Findings Although initial studies suspected the increased prevalence of traditional CVD risk factors and side effects of ART to be involved in the increased CVD risk in PLWH, recent studies have uncovered the important role of chronic persistent inflammation in this increased risk. In addition, biomarkers of inflammation have been associated with both CVD events and subclinical CAD in this population. Lastly, recent studies and ongoing clinical trials have been investigating medical interventions that aim to reduce inflammation and cardiovascular events. Summary Different mechanisms of inflammation have been examined in PLWH, including subclinical viremia, microbial translocation, and coinfection with other pathogens such as cytomegalovirus. Although inflammatory biomarkers have been consistently associated with CVD and subclinical CVD outcomes, their prognostic value is unknown. Recent and ongoing trials are exploring the benefits of anti-inflammatory drugs, statins, and antimicrobial translocation drugs on both inflammation and CVD risk among PLWH.

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Atrial Fibrillation and Atrial Flutter in Human Immunodeficiency Virus-Infected Persons

Abstract: In a large HIV-infected cohort, markers of HIV disease severity represented by low CD4(+) cell count and high viral load, assessed by multiple time-updated measures, were independently associated with development of AF.

Cited by 84 publications

References 33 publications

HIV Infection and Risk of Cardiovascular Diseases Beyond Coronary Artery Disease

HIV Infection and Risk of Cardiovascular Diseases Beyond Coronary Artery Disease

CHA2DS2-VASc Score, Warfarin Use, and Risk for Thromboembolic Events Among HIV-Infected Persons With Atrial Fibrillation

Coronary Artery Disease in HIV-Infected Patients: Downside of Living Longer

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