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March 11, 2020
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Severity of HIV affects HF risk

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Those with more severe HIV infection are at greater risk for developing HF, according to data presented at CROI.

Jennifer O. Lam, PhD, MPH, postdoctoral research fellow at the Kaiser Permanente Northern California Division of Research, and colleagues evaluated whether HF risk varies by HIV severity for patients who were members of Kaiser Permanente integrated health care delivery systems in Northern California, Southern California and the Mid-Atlantic states (Maryland/Virginia/Washington, D.C.) between 2000 and 2016. They matched 38,868 people with HIV to a comparator group of 386,569 people without HIV. The mean age of both groups was 41 years, and the groups consisted of 88% men, 38% white individuals, 21% black individuals and 20% Hispanic individuals.

“As people with HIV reach older ages, they are at risk for cardiovascular disease and other related conditions,” Lam said during her presentation. “Prior studies have found that people with HIV are at higher risk for developing heart failure compared to people without HIV. Multiple factors likely contribute to heart failure risk in people with HIV, including traditional cardiovascular risk factors such as smoking and high blood pressure, as well as factors that are unique to HIV, such as adverse metabolic effects from antiretroviral medications and HIV-mediated inflammation or immunodeficiency. The objective of our study was to evaluate whether heart failure risk varies by severity of HIV infection.”

The study found that HF risk was most elevated in people with more severe HIV infection, as defined by CD4 and HIV RNA levels.

In the metric of recent CD4 count, compared with people without HIV, people with HIV and CD4 count less than 200 cells/mm3 were at the highest risk for HF (adjusted RR = 2.83; 95% CI, 2.21-3.63) compared with those without HIV. People with HIV and CD4 count between 200 cells/mm3 and 499 cells/mm3 had more moderately increased risk (aRR = 1.52; 95% CI, 1.31-1.77), while people with HIV and a CD4 count of 500 cells/mm3 or more were not at elevated risk (aRR = 0.99; 95% CI, 0.84-1.16) compared with those without HIV, Lam said.

For nadir CD4 count, people with HIV and nadir CD4 of less than 200 cells/mm3 were at elevated risk for HF compared with people without HIV (aRR = 1.55; 95% CI, 1.35-1.77), whereas there was a nonsignificant trend for people with HIV and nadir CD4 of 200 cells/mm3 to 499 cells/mm3 (aRR = 1.17; 95% CI, 0.99-1.38) and no elevated risk for people with HIV and nadir CD4 of 500 cells/mm3 or more (aRR = 1; 95% CI, 0.68-1.48), according to the researchers.

For recent HIV RNA level, compared with no HIV, those with HIV and a level of 201 copies/mL to 9,999 copies/mL (aRR = 2.03; 95% CI, 1.36-3.02) or a level of 10,000 copies/mL or more (aRR = 2.13; 95% CI, 1.46-3.12) were at elevated risk for HF, but people with HIV and a level of less than 200 copies/mL were not (aRR = 1.4; 95% CI, 0.52-3.75), Lam said. These analyses accounted for potential differences in HF risk due to sociodemographic characteristics and prior diagnoses of CVD-related conditions such as diabetes, hypertension and hyperlipidemia. However, the researchers were not able to account for patterns of treatment for these conditions or individual behaviors such as diet and exercise.

“We found that people with HIV who were immunosuppressed or had higher HIV viremia were at greater risk of developing heart failure than people without HIV. This suggests that in addition to addressing cardiovascular risk factors, earlier HIV diagnosis and treatment, and adherence to antiretroviral therapy, may help reduce the burden of heart failure in people with HIV,” Lam said during her presentation. “This study extends prior research in this area by examining heart failure risk in a large patient population drawn from the same health care system and therefore minimizing any differences that could be due to differential access to healthcare by HIV status.” – by Erik Swain

Reference:

Lam JO, et al. Abstract 646. Presented at: Conference on Retroviruses and Opportunistic Infections; March 8-11, 2020; Boston.

Disclosure: Lam reports no relevant financial disclosures.

Editor’s Note: This article was updated on March 12, 2020 to correct the tiers in the HIV RNA level analysis and to make other changes requested by Dr. Lam. The Editors regret the error.