HIV confers elevated rates of sudden cardiac death, myocardial fibrosis
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Compared with those without HIV, HIV-positive individuals had higher rates of sudden cardiac death and myocardial fibrosis, and one-third of sudden cardiac deaths in people with HIV were due to occult drug overdose, researchers reported.
“In the current study, we sought to determine the underlying causes of all presumed sudden cardiac deaths and the precise incidence of sudden death caused by arrythmia in HIV-positive persons and to compare these data with those in the countywide population without known HIV infection,” Zian H. Tseng, MD, cardiac electrophysiologist and professor of medicine at the University of California, San Francisco, and colleagues wrote in The New England Journal of Medicine.
For the HIV POST SCD study, researchers identified all new deaths due to out-of-hospital cardiac arrest in San Francisco County among individuals aged 18 to 90 years with or without HIV infection from February 2011 to September 2016. Comprehensive autopsy and toxicologic and histologic testing were performed, and researchers compared sudden cardiac death rates and sudden death caused by arrhythmia.
The prospective postmortem study included 109 deaths from out-of-hospital cardiac arrest in individuals with HIV, of whom 48 met WHO criteria for presumed sudden cardiac death. Of the 48, 22 deaths were caused by arrhythmia. From February 2011 to March 2014, 505 presumed sudden cardiac deaths occurred in individuals without HIV.
According to the researchers, the incidence of presumed sudden cardiac death was 53.3 deaths per 100,000 person-years among individuals with HIV and 23.7 deaths per 100,000 person-years among individuals without HIV (incidence RR = 2.25; 95% CI, 1.37-3.7). In addition, incidence for sudden death caused by arrythmia was 25 deaths per 100,000 person-years among individuals with HIV and 13.3 deaths per 100,000 person-years among individuals without HIV (incidence RR = 1.87; 95% CI, 0.93-3.78).
The researchers also found that among people who experienced sudden cardiac death, occult drug overdose was more common among individuals with HIV than in those without it (34% vs. 13%).
Tseng and colleagues found higher histologic levels of interstitial myocardial fibrosis in individuals with HIV compared with those without HIV (mean percent fibrosis, 12.5% vs. 8.7% in those with presumed sudden cardiac death; 13.8% vs. 9.7% in those with death from arrhythmia; 11.3% vs. 7% in those with death from nonarrhythmic causes).
“In this prospective countywide postmortem investigation of all deaths attributed to out-of-hospital cardiac arrest, we found a higher incidence of presumed sudden cardiac death among persons with known HIV infection than among persons without known HIV infection,” the researchers wrote. “Interstitial myocardial fibrosis was also more extensive in HIV-positive persons.”
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