Clinical characteristics of HIV-infected patients with adjudicated heart failure

Abstract

Aims HIV-infected persons may have elevated risks for heart failure, but factors associated with heart failure in the modern era of HIV therapy are insufficiently understood. Despite substantial disagreement between physician-adjudicated heart failure and heart failure diagnosis codes, few studies of HIV cohorts have evaluated adjudicated heart failure. We evaluated associations of HIV viremia, immunosuppression, and cardiovascular risk factors with physician-adjudicated heart failure. Methods and results We analyzed clinical characteristics associated with heart failure in a cohort of 5041 HIV-infected patients receiving care at an urban hospital system between 2000 and 2016. We also evaluated characteristics of HIV-infected patients who screened negative for heart failure, screened positive for possible heart failure but did not have heart failure after adjudication, and had adjudicated heart failure. HIV-infected patients with heart failure (N = 216) were older and more likely to be black, hypertensive, and have diabetes than HIV-infected patients without heart failure; heart failure with reduced ejection fraction was more common than heart failure with preserved ejection fraction. In our primary analyses restricted to HIV-infected patients whose heart failure diagnoses did not precede their HIV diagnoses (N = 149), peak HIV viral load ≥100,000 copies/mL (odds ratio (OR) 2.12, 1.28–3.52) and nadir CD4 T-cell count <200 cells/mm3 (OR 2.35, 1.04–5.31) were associated with significantly elevated odds of heart failure. Overall, 30.6% of patients with any diagnosis code of heart failure had adjudicated heart failure. Conclusion Higher peak HIV viremia and lower CD4 cell nadir are associated with significantly elevated odds of heart failure for HIV-infected persons. Physician adjudication of heart failure may be helpful in HIV cohorts.

Editor’s presentation

“…Lower nadir CD4 cell count and higher HIV viraemia were associated with significantly greater odds of adjudicated heart failure even after adjustment for demographics, cardiovascular disease risk factors and HIV-related medication use. 10 These results support a potential role of HIV-associated immunodeficiency and viraemia in HIV-associated heart failure pathogenesis.…”

Diastolic Dysfunction in Individuals With Human Immunodeficiency Virus Infection: Literature Review, Rationale and Design of the Characterizing Heart Function on Antiretroviral Therapy (CHART) Study

“…In that study, ~ 40% of HF cases were classified as HFpEF (LVEF ≥50%). 19 Peak HIV viral load ≥100,000 copies/mL and nadir CD4 count <200 cells/mm 3 were associated with significantly elevated odds of HF. 19 Taken together, these data imply that immune processes modulate risk for HF in HIV-infected persons.…”

“…18 Of note, a CD4 count <200 cells/mm 3 was associated with an increased risk for both HF with preserved and reduced LVEF. 18 In a cohort of 5041 HIV-infected patients receiving care at an urban setting, 19 patients with HF ( N = 216) were older and more likely to be black, hypertensive, and have diabetes. In that study, ~ 40% of HF cases were classified as HFpEF (LVEF ≥50%).…”

Ventricular Ectopy and Arrhythmia Characteristics for Persons Living with HIV and Uninfected Controls

“…We studied a nested cohort of the HIV Electronic Comprehensive Cohort of CVD Complications (HIVE-4CVD), which consists of HIV+ and uninfected persons receiving care at Northwestern Medicine (Chicago, Illinois) frequency matched on age, sex, race/ethnicity, and Zip code of residence. 11,14,15 Clinical data within HIVE-4CVD were obtained during the course of clinical care between January 1, 2000, and July 12, 2016, and available for analysis for all study participants. Participants were excluded from analysis for this study if they had no visits with body weight recorded in the medical record, as the absence of this data point suggests a lack of meaningful clinical visits and interaction in the health system.…”