Abstract
Introduction: Current evidence suggests a 1 to 2-fold increased risk of heart failure among persons living with HIV (PWH), with possible underlying mechanisms including increased vascular stiffness, chronic inflammation and myocardial toxicity. This study evaluated the prevalence of HFpEF and differences in cardiovascular complications in PWH with and without HFpEF. Methods: Participants included 257 of 965 PWH at our Special Immunology Clinic at the Jackson Memorial and University of Miami Hospitals from 2017-19. Demographic, clinical, and laboratory information, were obtained from retrospective review of the electronic health records. HFpEF was confirmed by clinical and echocardiography findings, from which H2FpEF score was derived. Patients with an EF <50% were excluded. Results: The prevalence of HFpEF was 0.7%, while the mean H2FpEF score was 3.3±1.4. Thus, on average the cohort had an intermediate probability of HFpEF. When comparing persons with compared with those without HFpEF, mean age (56.4 vs. 52.0 years) and proportion of women (57.1 vs.45.0%) did not significantly differ. Similarly, groups did not differ on mean CD4 count (665 vs. 568 cells/uL, p=0.40), % with undetectable Viral Load (85.7% vs. 71.6%, p=0.41), or antiretroviral therapy use (100.0% vs. 92.8%, p=0.46). Of note, the prevalence of coronary artery disease (CAD) (14.3% vs. 1.6%, p=0.009), myocardial infarction (28.6 vs. 1.8%, p<0.001), abnormal stress testing (14.3% vs. 0.8%, p=0.001), PCI (14.3% vs. 0.9%, p=0.001), type II diabetes (57.1% vs. 16.0%, p=0.003), HbA1C (8.0±2.9% vs. 5.9±1.4%, p=0.004) and chronic kidney disease (57.1% vs. 10.2%, p<0.001) were higher in PWH with HFpEF. Of note, the groups had comparable mean EF (55.0 vs. 56.0%, p=0.66), diastolic dysfunction (33.3% vs. 41.9%, p=0.68), left ventricular (LV) hypertrophy (28.6% vs. 20.9%, p=0.62) and LV mass index (86.4±30.8 vs. 79.1±23.2 g/m2, p=0.34). Conclusions: The overall prevalence was similar to that reported in persons 45 years of age or more in the general population. Risk markers for atherosclerotic disease were significantly higher in PWH with HFpEF. HIV disease severity did not appear to be associated with HFpEF prevalence. Further studies evaluating the pathophysiology of HFpEF in PWH are needed.