Sudden Cardiac Death and Sudden Cardiac Arrest in Patients with Human Immunodeficiency Virus: A Systematic Review

Abstract

The importance of this review lies in its study of the risk of sudden cardiac death (SCD) and sudden cardiac arrest (SCA) in people living with the human immunodeficiency virus (PLWH). To the best of our knowledge, this is the first review investigating the effect of the human immunodeficiency virus (HIV) on SCD and SCA. The review's objective was to determine the risk of SCD and SCA in PLWH. To do this, the electronic databases Ovid MEDLINE, EMBASE, Cochrane Central, Scopus, and Google Scholar were systematically searched to identify eligible studies published before January 31, 2021. Reference lists of the included studies were searched for further identification of relevant studies. The search terms included: "Sudden Cardiac Death," "Sudden Cardiac Arrest," "Human Immunodeficiency virus," "HIV," "Acquired immunodeficiency syndrome," and "AIDS." Only observational studies that assessed the association between SCD and SCA in PWLH were selected. Data were extracted by two independent authors who screened titles, abstracts, and articles to meet the inclusion criterion. Quality assessment was done by using modified Downs and Black checklist. A total of seven studies were included in this review. Five studies revealed a higher incidence of SCD in PLWH, two of which focused on patients with HIV and low left ventricular ejection fraction (LVEF). The other two studies were about the association of HIV and SCA. Studies reported that PLWH had a three-to five-fold higher incidence of SCD as compared to non-HIV patients. HIV patients with low LVEF had a higher incidence of SCD than HIV patients with normal LVEF. PLWH had a higher incidence of SCA and less successful cardiopulmonary resuscitation (CPR) as compared to patients without HIV. After adjusting for various confounders in multiple studies, all the studies reported a higher incidence of SCD in PLWH. To conclude, PLWH is at an increased risk of SCD and SCA. Some risk factors for this include LVEF, viral load (VL), and the cluster of differentiation 4 (CD4) count. There is a paucity of data on the mechanisms involved, although a higher prevalence of cardiac fibrosis and interstitial fibrosis in PLWH may play a role. Because of the general suboptimal quality of the heterogeneous nature of the current evidence, further, rigorous studies are needed to determine the association of increased risk of SCD and SCA in PLWH.

Prediction of Sudden Cardiac Arrest in the General Population: Review of Traditional and Emerging Risk Factors

“…The incidence rate of SCD among PLWH was shown to be 2-4 fold higher than those without HIV infection. [73] Recent data obtained from cardiac magnetic resonance imaging (CMR) and autopsy have shown that diffuse myocardial fibrosis, a risk factor for SCD, is prevalent among PLWH. [74,75] Other possible factors which contribute to the increased risk of SCD among PLWH include: (i) high prevalence of coronary artery disease [76], (ii) concomitant illicit drug use [76,77], and (iii) QT prolongation due to medications and possibly from a direct effect of HIV infection [77].…”

HIV-Tat Exacerbates the Actions of Atazanavir, Efavirenz, and Ritonavir on Cardiac Ryanodine Receptor (RyR2)

“…The incidence of sudden cardiac death (SCD) in people living with HIV infection (PLWH), especially those with inadequate viral suppression, is significantly higher than that of the general population [1][2][3][4][5][6]. The risk factors that contribute to this include sex, vascular aging, hyperactive sympathetic and immune systems, inflammation, cardiac ischemia and fibrosis, and illicit and prescription drug use [1,[5][6][7][8][9][10][11].…”

The power and wisdom of prevention. Cardiovascular risk, new challenge, and approach to PLWH

“…4 Initially the introduction of protease inhibitors (PIs) was associated with hyperlipidemia and consequently even a higher risk of major cardiovascular events. 5,6 However, the risk of CVD, including acute myocardial infarction, 7 sudden cardiac death, 8 stroke, 9,10 heart failure 11 and peripheral arterial disease, 12 remains signifi cantly higher than in the general population, and cannot be explained by PIs alone. 13 Some studies show a higher prevalence of cardiovascular risk factors, such as hypertension, cigarette smoking, 14 metabolic syndrom, 15 diabetes, 16 dyslipidemia, 17 and depression 18 in HIV-infected individuals compared with uninfected individuals.…”