Abstract
Heart Failure
People with human immunodeficiency virus (PWH) have an improved life expectancy because of the wide availability of antiretroviral therapy (ART), resulting in an increased prevalence of heart failure (HF). Determining whether PWH and HF have specific associations to risk factors is critical because HF subtypes differ in the underlying mechanism, treatment, and prognosis.
We performed a retrospective chart review of PWH who received care at the University of Miami/Jackson Memorial Hospital HIV clinics between 2017-2019 (N=1,166). Patients with an available echocardiogram or documented HF were included for analysis (n=305). Heart failure was defined as having an ejection fraction (EF) <55% or having documentation of any subtype of HF (n=52). Not having HF was defined as having an EF ≥ 55% and not having documented HF or Heart Failure with preserved ejection fraction (HFpEF) (n=253). Data regarding demographic, clinical, imaging, and laboratory results was obtained.
The overall prevalence of HF was 17%, of which 53.8% were men and 46.2% were women. There was no difference in age or gender among the groups. When compared to PWH without HF, those with HF were less likely to be Hispanic (27.9% vs. 11.5%, p=0.012), had significantly greater prevalence of chronic kidney disease (17.8% vs. 46.2%, p <0.001), history of previous myocardial infarction (2.8% vs.13.5%, p= 0.004), higher prevalence of coronary artery disease (2.8% vs.17.3%, p<0.001), hypertension (53.8% vs.80.8%, p<0.001), had undergone more percutaneous coronary intervention (2% vs. 18.6%, p<0.001), and echocardiogram showed greater incidence of pericardial effusion (11.2% vs. 30.8% p<0.001), more diastolic dysfunction (39.3% vs. 62.7%, p= 0.003), higher LV Mass (148.7g vs 183.8g, p<0.001) and more left ventricle hypertrophy (23.9% vs. 38.5%, p=0.038).
We found a higher prevalence of HF (17%) in our cohort when compared to uninfected individuals (2.2% AHA 2020). Hypertension, myocardial infarction, and CVD were more prevalent in PWH with HF. We found no significant difference in HIV-associated factors like CD4 count and viral load between PWH with and without HF. A strategy that prioritizes HIV infection treatment, heart failure risk factor prevention, hypertension control, management, and risk stratification would benefit this high-risk population.