HIV 感染者的心力衰竭风险因 HIV 严重程度和性别而异。
Variation in Heart Failure Risk by HIV Severity and Sex in People With HIV Infection.
机构信息
Division of Research, Kaiser Permanente Northern California, Oakland, CA.
Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, MD.
出版信息
J Acquir Immune Defic Syndr. 2022 Oct 1;91(2):175-181. doi: 10.1097/QAI.0000000000003032.
BACKGROUND
HIV is an independent risk factor for heart failure (HF). However, the association of HIV severity with incident HF and the potential interaction with sex are incompletely understood.
SETTING
Integrated health care system.
METHODS
We conducted a cohort study of people with HIV (PWH) and matched people without HIV (PWoH), all aged ≥ 21 years and with no previous HF. Poisson regression was used to compare incident HF by HIV status, with PWH stratified by severity of HIV infection [defined by recent (<6 months) CD4 count, nadir CD4 count, or recent HIV RNA level]. Models were adjusted for sociodemographic characteristics, substance use, and HF risk factors. Analyses were conducted for men and women combined, then by sex.
RESULTS
The study included 38,868 PWH and 386,569 PWoH (mean baseline age = 41.0 ± 10.8 years; 88% men). Compared with PWoH, incident HF risk was higher among PWH with lower recent CD4 [200-499 cells/µL, adjusted rate ratio (aRR) = 1.82, 95% confidence interval (CI) = 1.50 to 2.21 and <200 cells/µL, aRR = 3.26 (2.47 to 4.30)] and a low nadir CD4 [<200 cells/µL, aRR = 1.56 (1.37 to 1.79)] but not among PWH with normal CD4 [≥500 cells/µL, aRR = 1.14 (0.90 to 1.44)]. Higher incident HF risk was observed among PWH at all HIV RNA levels, with greater HF risk at higher HIV RNA levels. The excess HF risk associated with low CD4 (recent or nadir) and high HIV RNA was stronger among women than men (P interactions=0.05, 0.08, and 0.01, respectively).
CONCLUSIONS
Given the association of HIV severity with HF, optimizing HIV treatment and management may be important for HF prevention among PWH.
背景
HIV 是心力衰竭（HF）的独立危险因素。然而，HIV 严重程度与 HF 发病的关系以及与性别的潜在相互作用尚不完全清楚。
设置
综合医疗保健系统。
方法
我们对 HIV 感染者（PWH）和匹配的无 HIV 感染者（PWoH）进行了队列研究，所有参与者年龄均≥21 岁，且无既往 HF。使用泊松回归比较 HIV 状态与 HF 发病的关系，根据最近（<6 个月）CD4 计数、最低 CD4 计数或最近 HIV RNA 水平对 PWH 进行 HIV 感染严重程度分层。模型调整了社会人口统计学特征、物质使用和 HF 危险因素。对男性和女性进行了联合分析，然后按性别进行分析。
结果
本研究纳入了 38868 名 PWH 和 386569 名 PWoH（平均基线年龄=41.0±10.8 岁；88%为男性）。与 PWoH 相比，近期 CD4 计数较低（200-499 个细胞/µL，调整后的比率比[aRR]为 1.82，95%置信区间[CI]为 1.50 至 2.21；<200 个细胞/µL，aRR 为 3.26（2.47 至 4.30））和低最低 CD4 计数 [<200 个细胞/µL，aRR 为 1.56（1.37 至 1.79）]的 PWH 发生 HF 的风险更高，但 CD4 正常[≥500 个细胞/µL，aRR 为 1.14（0.90 至 1.44）]的 PWH 则不然。所有 HIV RNA 水平的 PWH 发生 HF 的风险均较高，HIV RNA 水平越高，HF 风险越大。与低 CD4（近期或最低）和高 HIV RNA 相关的 HF 风险在女性中高于男性（P 交互作用=0.05、0.08 和 0.01）。
结论
鉴于 HIV 严重程度与 HF 的关系，优化 HIV 治疗和管理可能对 PWH 的 HF 预防很重要。
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