Section of Cardiac Electrophysiology, Division of Cardiology, University of California-San Francisco, San Francisco, CA 94313, USA.
J Am Coll Cardiol. 2012 May 22;59(21):1891-6. doi: 10.1016/j.jacc.2012.02.024.
The aim of this study was to determine the incidence and clinical characteristics of sudden cardiac death (SCD) in patients with human immunodeficiency virus (HIV) infection.
As the HIV-infected population ages, cardiovascular disease prevalence and mortality are increasing, but the incidence and features of SCD have not yet been described.
The records of 2,860 consecutive patients in a public HIV clinic in San Francisco between April 2000 and August 2009 were examined. Identification of deaths, causes of death, and clinical characteristics were obtained by search of the National Death Index and/or clinic records. SCDs were determined using published retrospective criteria: 1) the International Classification of Diseases-10th Revision, code for all cardiac causes of death; and (2) circumstances of death meeting World Health Organization criteria.
Of 230 deaths over a median of 3.7 years of follow-up, 30 (13%) met SCD criteria, 131 (57%) were due to acquired immune deficiency syndrome (AIDS), 25 (11%) were due to other (natural) diseases, and 44 (19%) were due to overdoses, suicides, or unknown causes. SCDs accounted for 86% of all cardiac deaths (30 of 35). The mean SCD rate was 2.6 per 1,000 person-years (95% confidence interval: 1.8 to 3.8), 4.5-fold higher than expected. SCDs occurred in older patients than did AIDS deaths (mean 49.0 vs. 44.9 years, p = 0.02). Compared with AIDS and natural deaths combined, SCDs had a higher prevalence of prior myocardial infarction (17% vs. 1%, p < 0.0005), cardiomyopathy (23% vs. 3%, p < 0.0005), heart failure (30% vs. 9%, p = 0.004), and arrhythmias (20% vs. 3%, p = 0.003).
SCDs account for most cardiac and many non-AIDS natural deaths in HIV-infected patients. Further investigation is needed to ascertain underlying mechanisms, which may include inflammation, antiretroviral therapy interruption, and concomitant medications.
本研究旨在确定人类免疫缺陷病毒（HIV）感染者中心律失常性猝死（SCD）的发生率和临床特征。
随着 HIV 感染人群的老龄化，心血管疾病的患病率和死亡率正在上升，但 SCD 的发生率和特征尚未得到描述。
对 2000 年 4 月至 2009 年 8 月间在旧金山一家公立 HIV 诊所就诊的 2860 例连续患者的记录进行了检查。通过搜索国家死亡索引和/或诊所记录，确定了死亡人数、死因和临床特征。使用发表的回顾性标准确定 SCD：1）国际疾病分类第 10 次修订版，所有心脏原因导致死亡的代码；2）符合世界卫生组织标准的死亡情况。
在中位随访 3.7 年期间，有 230 例死亡，30 例（13%）符合 SCD 标准，131 例（57%）归因于获得性免疫缺陷综合征（AIDS），25 例（11%）归因于其他（自然）疾病，44 例（19%）归因于过量用药、自杀或不明原因。SCD 占所有心脏死亡的 86%（30/35）。SCD 的平均发生率为每 1000 人年 2.6 例（95%置信区间：1.8 至 3.8），是预期的 4.5 倍。与 AIDS 死亡相比，SCD 发生在年龄较大的患者中（平均 49.0 岁 vs. 44.9 岁，p = 0.02）。与 AIDS 和自然死亡合并相比，SCD 更常见于既往心肌梗死（17% vs. 1%，p < 0.0005）、心肌病（23% vs. 3%，p < 0.0005）、心力衰竭（30% vs. 9%，p = 0.004）和心律失常（20% vs. 3%，p = 0.003）。
SCD 占 HIV 感染者中心律失常和许多非 AIDS 自然死亡的大部分。需要进一步调查以确定潜在机制，这些机制可能包括炎症、抗逆转录病毒治疗中断和伴随药物治疗。
