Providence VA Medical Center, Providence, Rhode Island; Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island.
Providence VA Medical Center, Providence, Rhode Island.
JACC Heart Fail. 2020 Jun;8(6):501-511. doi: 10.1016/j.jchf.2019.12.007. Epub 2020 Apr 8.
This study sought to investigate outcomes of heart failure (HF) in veterans living with human immunodeficiency virus (HIV).
Data on outcomes of HF among people living with human immunodeficiency virus (PLHIV) are limited.
We performed a retrospective cohort study of Veterans Health Affairs data to investigate outcomes of HF in PLHIV. We identified 5,747 HIV+ veterans with diagnosis of HF from 2000 to 2018 and 33,497 HIV- frequency-matched controls were included. Clinical outcomes included all-cause mortality, HF hospital admission, and all-cause hospital admission.
Compared with HIV- veterans with HF, HIV+ veterans with HF were more likely to be black (56% vs. 14%), be smokers (52% vs. 29%), use alcohol (32% vs. 13%) or drugs (37% vs. 8%), and have a higher comorbidity burden (Elixhauser comorbidity index 5.1 vs. 2.6). The mean ejection fraction (EF) (45 ± 16%) was comparable between HIV+ and HIV- veterans. HIV+ veterans with HF had a higher age-, sex-, and race-adjusted 1-year all-cause mortality (30.7% vs. 20.3%), HF hospital admission (21.2% vs. 18.0%), and all-cause admission (50.2% vs. 38.5%) rates. Among veterans with HIV and HF, those with low CD4 count (<200 cells/ml) and high HIV viral load (>75 copies/μl) had worse outcomes. The associations remained statistically significant after adjusting for extensive list of covariates. The incidence of all-cause mortality and HF admissions was higher among HIV+ veterans with ejection fraction <45% CONCLUSIONS: HIV+ veterans with HF had higher risk of hospitalization and mortality compared with their HIV- counterparts, with worse outcomes reported for individuals with lower CD4 count, higher viral load, and lower ejection fraction.
本研究旨在探讨合并人类免疫缺陷病毒（HIV）感染的退伍军人心力衰竭（HF）的结局。
目前关于合并 HIV 感染的人群（PLHIV）HF 结局的数据有限。
我们对退伍军人事务部数据进行了回顾性队列研究，以调查 PLHIV 中 HF 的结局。我们确定了 2000 年至 2018 年间诊断为 HF 的 5747 名 HIV+退伍军人，并纳入了 33497 名 HIV-频数匹配对照。临床结局包括全因死亡率、HF 住院率和全因住院率。
与 HIV-合并 HF 的退伍军人相比，HIV+合并 HF 的退伍军人更有可能为黑人（56% vs. 14%）、吸烟者（52% vs. 29%）、饮酒（32% vs. 13%）或吸毒（37% vs. 8%），且合并症负担更重（Elixhauser 合并症指数 5.1 vs. 2.6）。HIV+和 HIV-合并 HF 的退伍军人的平均射血分数（EF）（45±16%）相似。HF 合并 HIV 的退伍军人 1 年全因死亡率（30.7% vs. 20.3%）、HF 住院率（21.2% vs. 18.0%）和全因住院率（50.2% vs. 38.5%）均较高。在合并 HIV 和 HF 的退伍军人中，CD4 计数<200 个细胞/ml 和 HIV 病毒载量>75 拷贝/μl 的患者结局较差。调整了大量协变量后，相关性仍具有统计学意义。EF<45%的 HIV+HF 退伍军人全因死亡率和 HF 入院率更高。
HF 合并 HIV 的退伍军人住院和死亡风险高于 HIV-对照者，CD4 计数较低、病毒载量较高和 EF 较低的患者预后更差。
