Beydoun Nour, Nance Robin M, Durstenfeld Matthew S, Hoffmann Alexander P, Whitney Bridget M, Burkholder Greer A, Health Sonya, Hsue Priscilla Y, Saag Michael, Delaney Joseph Ac, Longenecker Chris T, Crane Heidi M, Feinstein Matthew J
Northwestern University Feinberg School of Medicine, Chicago, Illinois.
University of Washington, Seattle, Washington.
AIDS. 2025 Jul 15;39(9):1246-1253. doi: 10.1097/QAD.0000000000004182. Epub 2025 Mar 17.
Limited systematic data exist on heart failure phenotypes in contemporary HIV care, and no prior multicenter studies have investigated physician-adjudicated phenotypes and causes of heart failure in people with HIV (PWH).
We adjudicated heart failure events and sub-phenotypes occurring between January 1, 2010, and December 31, 2021, at two large urban clinical centers within the CFAR Network of Integrated Clinical Systems (CNICS) cohort. Using Cox proportional hazard regression, hazard ratios were calculated to examine associations of HIV-specific and cardiometabolic risk factors with incident heart failure among PWH. Exploratory analyses investigated presence of physician-adjudicated ischemic and nonischemic causes of HF.
Of 402 individuals with events screened as possible heart failure, 289 were adjudicated as heart failure. Of these 289, 77 were prevalent at baseline and 212 were incident. Higher viral load and lower CD4 + T cell count were associated with incident heart failure. In addition, older age, smoking, hypertension, diabetes mellitus, history of myocardial infarction (MI), and renal insufficiency were associated with higher heart failure risk. Nonischemic heart failure causes were more common than ischemic, and heart failure with reduced ejection fraction (HFrEF) was more common than preserved ejection fraction (HFpEF). Despite distinct demographic and risk factor compositions between the two sites, heart failure phenotypes were similar.
HIV viremia, low CD4 + T cell count, traditional CVD risk factors, and renal insufficiency were associated with higher risk for heart failure. The predominant heart failure subtype was nonischemic heart failure. While further studies are needed, our findings suggest heart failure prevention and management in PWH will require addressing complex interactions between HIV-related and traditional CVD risk factors.
当代艾滋病病毒（HIV）治疗中关于心力衰竭表型的系统性数据有限，且此前尚无多中心研究调查过经医生判定的HIV感染者（PWH）心力衰竭的表型及病因。
我们对2010年1月1日至2021年12月31日期间在综合临床系统CFAR网络（CNICS）队列中的两个大型城市临床中心发生的心力衰竭事件及亚表型进行了判定。使用Cox比例风险回归计算风险比，以检验HIV特异性和心脏代谢风险因素与PWH发生心力衰竭之间的关联。探索性分析调查了经医生判定的心力衰竭的缺血性和非缺血性病因。
在402名筛查出可能发生心力衰竭事件的个体中，289名被判定为心力衰竭。在这289名患者中，77名在基线时已患有心力衰竭，212名是新发的。较高的病毒载量和较低的CD⁺4 T细胞计数与新发心力衰竭相关。此外，年龄较大、吸烟、高血压、糖尿病、心肌梗死（MI）病史和肾功能不全与较高的心力衰竭风险相关。非缺血性心力衰竭病因比缺血性更常见，射血分数降低的心力衰竭（HFrEF）比射血分数保留的心力衰竭（HFpEF）更常见。尽管两个研究地点的人口统计学和风险因素构成不同，但心力衰竭表型相似。
HIV病毒血症、低CD⁺4 T细胞计数、传统心血管疾病风险因素和肾功能不全与较高的心力衰竭风险相关。主要的心力衰竭亚型是非缺血性心力衰竭。虽然还需要进一步研究，但我们的研究结果表明，预防和管理PWH的心力衰竭将需要解决HIV相关和传统心血管疾病风险因素之间的复杂相互作用。
