Feinberg School of Medicine, Northwestern University, USA.
Eur J Prev Cardiol. 2017 Nov;24(16):1746-1758. doi: 10.1177/2047487317732432. Epub 2017 Sep 25.
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/mm (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.
HIV 感染者发生心力衰竭的风险可能会升高，但在 HIV 治疗的现代时代，与心力衰竭相关的因素还不够明确。尽管医生判定的心力衰竭与心力衰竭诊断代码之间存在很大分歧，但很少有 HIV 队列研究评估过有争议的心力衰竭。我们评估了 HIV 病毒血症、免疫抑制和心血管危险因素与医生判定的心力衰竭之间的关系。
我们分析了在 2000 年至 2016 年间在一家城市医院系统接受治疗的 5041 名 HIV 感染者队列中与心力衰竭相关的临床特征。我们还评估了 HIV 感染者的特征，这些感染者筛查时无心力衰竭，但可能存在心力衰竭（经裁决后未确诊为心力衰竭），以及经裁决后确诊为心力衰竭。与无心力衰竭的 HIV 感染者相比，有心力衰竭的 HIV 感染者（N=216）年龄更大，更可能为黑人、高血压和患有糖尿病；心力衰竭射血分数降低比射血分数保留更常见。在我们对心力衰竭诊断未先于 HIV 诊断的 HIV 感染者（N=149）进行的主要分析中，HIV 病毒载量峰值≥100,000 拷贝/ml（比值比[OR]2.12，1.28-3.52）和 CD4 细胞计数最低值<200 个/mm（OR 2.35，1.04-5.31）与心力衰竭的发生风险显著增加相关。总体而言，30.6%有任何心力衰竭诊断代码的患者经裁决后确诊为心力衰竭。
HIV 感染者 HIV 病毒载量峰值较高和 CD4 细胞计数最低值较低与心力衰竭发生风险显著增加相关。对心力衰竭进行医生裁决可能有助于评估 HIV 感染者。
