Avula Harshith R, Ambrosy Andrew P, Silverberg Michael J, Reynolds Kristi, Towner William J, Hechter Rulin C, Horberg Michael, Vupputuri Suma, Leong Thomas K, Leyden Wendy A, Harrison Teresa N, Lee Keane K, Sung Sue Hee, Go Alan S
Department of Cardiology, Kaiser Permanente Walnut Creek Medical Center, Walnut Creek, CA 94596, USA.
Department of Cardiology, Kaiser Permanente San Francisco Medical Center, San Francisco, CA 94115, USA.
Eur Heart J Open. 2021 Dec 1;1(3):oeab040. doi: 10.1093/ehjopen/oeab040. eCollection 2021 Nov.
Human immunodeficiency virus (HIV) increases the risk of heart failure (HF), but whether it influences subsequent morbidity and mortality remains unclear.
We investigated the risks of hospitalization for HF, HF-related emergency department (ED) visits, and all-cause death in an observational cohort of incident HF patients with and without HIV using data from three large US integrated healthcare delivery systems. We estimated incidence rates and adjusted hazard ratios (aHRs) by HIV status at the time of HF diagnosis for subsequent outcomes. We identified 448 persons living with HIV (PLWH) and 3429 without HIV who developed HF from a frequency-matched source cohort of 38 868 PLWH and 386 586 without HIV. Mean age was 59.5 ± 11.3 years with 9.8% women and 31.8% Black, 13.1% Hispanic, and 2.2% Asian/Pacific Islander. Compared with persons without HIV, PLWH had similar adjusted rates of HF hospitalization [aHR 1.01, 95% confidence interval (CI): 0.81-1.26] and of HF-related ED visits [aHR 1.22 (95% CI: 0.99-1.50)], but higher adjusted rates of all-cause death [aHR 1.31 (95% CI: 1.08-1.58)]. Adjusted rates of HF-related morbidity and all-cause death were directionally consistent across a wide range of CD4 counts but most pronounced in the subset with a baseline CD4 count <200 or 200-499 cells/μL.
In a large, diverse cohort of adults with incident HF receiving care within integrated healthcare delivery systems, PLWH were at an independently higher risk of all-cause death but not HF hospitalizations or HF-related ED visits. Future studies investigating modifiable HIV-specific risk factors may facilitate more personalized care to optimize outcomes for PLWH and HF.
人类免疫缺陷病毒（HIV）会增加心力衰竭（HF）的风险，但它是否会影响后续的发病率和死亡率仍不清楚。
我们利用来自美国三个大型综合医疗服务系统的数据，在一个观察性队列中，对患有和未患有HIV的新发HF患者进行研究，调查其因HF住院、与HF相关的急诊科（ED）就诊以及全因死亡的风险。我们根据HF诊断时的HIV状态，对后续结局估计发病率和调整后的风险比（aHRs）。我们从38868名HIV感染者和386586名未感染HIV者的频率匹配源队列中，确定了448名HIV感染者（PLWH）和3429名未感染HIV者发生了HF。平均年龄为59.5±11.3岁，女性占9.8%，黑人占31.8%，西班牙裔占13.1%，亚太岛民占2.2%。与未感染HIV者相比，PLWH因HF住院的调整率相似[aHR 1.01，95%置信区间（CI）：0.81-1.26]，与HF相关的ED就诊调整率也相似[aHR 1.22（95%CI：0.99-1.50）]，但全因死亡的调整率更高[aHR 1.31（95%CI：1.08-1.58）]。在广泛的CD4计数范围内，与HF相关的发病率和全因死亡的调整率在方向上是一致的，但在基线CD4计数<200或200-499个细胞/μL的亚组中最为明显。
在一个接受综合医疗服务系统护理的大型、多样化的新发HF成年人群体中，PLWH全因死亡的独立风险更高，但HF住院或与HF相关的ED就诊风险并不高。未来研究可改变的HIV特异性危险因素，可能有助于为PLWH和HF患者提供更个性化的护理，以优化结局。
