deFilippi Christopher, Awwad Aya, Bloomfield Gerald S, Weir Isabelle R, Ribaudo Heather, Zanni Markella V, Fichtenbaum Carl J, Malvestutto Carlos D, Aberg Judith A, Diggs Marissa R, Chu Sarah M, Paradis Kayla, MacArthur Roger D, Pilotto Jose, Marks Kristen, Van Dam Cornelius, Wilkin Aimee, Currier Judith S, Zhao Sophia, Wiviott Stephen D, Lu Michael T, Douglas Pamela S, Grinspoon Steve
Inova Schar Heart and Vascular, Falls Church, Virginia, USA.
Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
AIDS. 2025 May 23. doi: 10.1097/QAD.0000000000004243.
People with HIV (PWH) are at increased risk of sudden cardiac death (SCD) but the mechanisms are unclear limiting prevention efforts. We leveraged the global REPRIEVE trial with carefully adjudicated atherosclerotic cardiovascular disease (ASCVD) outcomes to determine cardiac, behavioral, and HIV-specific risks associated with SCD and assess potential similarities to undetermined deaths (UDD).
DESIGN/METHODS: : REPRIEVE included 7769 PWH with low-to-moderate traditional ASCVD risk without known ASCVD randomized to pitavastatin vs placebo. Clinical features and ECGs were assessed at enrollment. Cox models assessed associations with SCD and UDD outcomes, adjusted for ASCVD risk and ART duration.
After a median of 5.6 years, 25 participants had SCD and 53 had UDD (incidence rate 0.61, 1.31 per1000 person-years, respectively). Of those with SCD, 84% were males, and the median 10-year ASCVD risk-score was 6.9% (IQR 3.5, 8.3) vs 5.7% (3.6, 8.8) for UDD vs 4.4% (2.1, 7.0) for participants without either outcome (n = 7691). Notably, 16.0% of the participants with SCD, 9.4% with UDD and 3.0% without either had major ECG abnormalities. In adjusted Cox models, substance abuse, and detectable HIV viral load were associated with an increased hazard of UDD but not SCD. Infarct/ischemic pattern and axis abnormalities on ECG were associated with increased hazard for SCD.
Among PWH with low-moderate ASCVD risk, subsequent SCD is associated with a higher burden of cardiovascular risk factors and ECG findings suggestive of subclinical structural abnormalities. In contrast, UDD is associated with a unique risk profile inclusive of HIV-specific and behavioral risks.
人类免疫缺陷病毒感染者（PWH）发生心源性猝死（SCD）的风险增加，但机制尚不清楚，这限制了预防措施的实施。我们利用全球REPRIEVE试验，该试验对动脉粥样硬化性心血管疾病（ASCVD）结局进行了仔细判定，以确定与SCD相关的心脏、行为和HIV特异性风险，并评估与不明原因死亡（UDD）的潜在相似性。
设计/方法：REPRIEVE纳入了7769例传统ASCVD风险低至中度且无已知ASCVD的PWH，随机分为匹伐他汀组和安慰剂组。入组时评估临床特征和心电图。Cox模型评估与SCD和UDD结局的关联，并根据ASCVD风险和抗逆转录病毒治疗持续时间进行调整。
中位随访5.6年，25例参与者发生SCD，53例发生UDD（发病率分别为每1000人年0.61例和1.31例）。在发生SCD的参与者中，84%为男性，10年ASCVD风险评分中位数为6.9%（四分位间距3.5，8.3），UDD为5.7%（3.6，8.8），无这两种结局的参与者为4.4%（2.1，7.0）（n = 7691）。值得注意的是，发生SCD的参与者中有16.0%、发生UDD的参与者中有9.4%以及无这两种结局的参与者中有3.0%有主要心电图异常。在调整后的Cox模型中，药物滥用和可检测到的HIV病毒载量与UDD风险增加相关，但与SCD无关。心电图上的梗死/缺血模式和电轴异常与SCD风险增加相关。
在ASCVD风险低至中度的PWH中，随后发生的SCD与更高的心血管危险因素负担以及提示亚临床结构异常的心电图表现相关。相比之下，UDD与包括HIV特异性和行为风险在内的独特风险特征相关。
