Division of Cardiovascular Medicine Vanderbilt University Medical Center Nashville TN.
Geriatric Research Education and Clinical Centers (GRECC) Veterans Affairs Tennessee Valley Healthcare System Nashville TN.
J Am Heart Assoc. 2021 Sep 21;10(18):e021268. doi: 10.1161/JAHA.121.021268. Epub 2021 Sep 8.
Background People living with HIV have higher sudden cardiac death (SCD) rates compared with the general population. Whether HIV infection is an independent SCD risk factor is unclear. Methods and Results This study evaluated participants from the Veterans Aging Cohort Study, an observational, longitudinal cohort of veterans with and without HIV infection matched 1:2 on age, sex, race/ethnicity, and clinical site. Baseline for this study was a participant's first clinical visit on or after April 1, 2003. Participants were followed through December 31, 2014. Using Cox proportional hazards regression, we assessed whether HIV infection, CD4 cell counts, and/or HIV viral load were associated with World Health Organization (WHO)-defined SCD risk. Among 144 336 participants (30% people living with HIV), the mean (SD) baseline age was 50.0 years (10.6 years), 97% were men, and 47% were of Black race. During follow-up (median, 9.0 years), 3035 SCDs occurred. HIV infection was associated with increased SCD risk (hazard ratio [HR], 1.14; 95% CI, 1.04-1.25), adjusting for possible confounders. In analyses with time-varying CD4 and HIV viral load, people living with HIV with CD4 counts <200 cells/mm (HR, 1.57; 95% CI, 1.28-1.92) or viral load >500 copies/mL (HR, 1.70; 95% CI, 1.46-1.98) had increased SCD risk versus veterans without HIV. In contrast, people living with HIV who had CD4 cell counts >500 cells/mm (HR, 1.03; 95% CI, 0.90-1.18) or HIV viral load <500 copies/mL (HR, 0.97; 95% CI, 0.87-1.09) were not at increased SCD risk. Conclusions HIV infection is associated with increased risk of WHO-defined SCD among those with elevated HIV viral load or low CD4 cell counts.
与普通人群相比，HIV 感染者的心脏性猝死（SCD）发生率更高。HIV 感染是否是独立的 SCD 危险因素尚不清楚。
本研究评估了 Veterans Aging Cohort Study 的参与者，该研究是一项观察性、纵向队列研究，纳入了 HIV 感染者和非 HIV 感染者，年龄、性别、种族/民族和临床地点按 1:2 匹配。本研究的基线是参与者在 2003 年 4 月 1 日或之后的首次临床就诊。参与者随访至 2014 年 12 月 31 日。使用 Cox 比例风险回归，我们评估了 HIV 感染、CD4 细胞计数和/或 HIV 病毒载量是否与世界卫生组织（WHO）定义的 SCD 风险相关。在 144336 名参与者（30%的 HIV 感染者）中，平均（SD）基线年龄为 50.0 岁（10.6 岁），97%为男性，47%为黑人。在随访期间（中位随访时间 9.0 年），发生了 3035 例 SCD。调整可能的混杂因素后，HIV 感染与 SCD 风险增加相关（风险比 [HR]，1.14；95%CI，1.04-1.25）。在 CD4 和 HIV 病毒载量随时间变化的分析中，CD4 计数<200 个细胞/mm（HR，1.57；95%CI，1.28-1.92）或病毒载量>500 拷贝/mL（HR，1.70；95%CI，1.46-1.98）的 HIV 感染者与未感染 HIV 的退伍军人相比，SCD 风险增加。相比之下，CD4 计数>500 个细胞/mm（HR，1.03；95%CI，0.90-1.18）或 HIV 病毒载量<500 拷贝/mL（HR，0.97；95%CI，0.87-1.09）的 HIV 感染者 SCD 风险未增加。
在 HIV 病毒载量升高或 CD4 细胞计数降低的患者中，HIV 感染与 WHO 定义的 SCD 风险增加相关。
