HIV Infection Linked to Heart Failure Risk

Laurie Barclay, MD

April 29, 2011

April 29, 2011 — HIV infection is a risk factor for heart failure (HF), with ongoing viral replication associated with higher risk, according to the results of a population-based, retrospective study reported in the April 25 issue of the Archives of Internal Medicine.

"Whether human immunodeficiency virus (HIV) infection is a risk factor for heart failure (HF) is not clear," according to previous research as cited in the current study. "The presence of coronary heart disease [CHD] and alcohol consumption in this population may confound this association."

In the current study, Adeel A. Butt, MD, MS, from the University of Pittsburgh School of Medicine, Pittsburgh, and Pittsburgh Healthcare System, Pennsylvania, and colleagues investigate this possible association between HIV and HF.

Their study population consisted of 8486 veterans, of whom 28.2% were HIV infected, enrolled in the Veterans Aging Cohort Study Virtual Cohort (VACS-VC) and the 1999 Large Health Study of Veteran Enrollees (LHS) from January 1, 2000, to July 31, 2007. There were 286 incident HF events during follow-up (median duration, 7.3 years).

Among HIV-infected veterans, age- and race/ethnicity–adjusted rates of HF were 7.12 (95% confidence interval [CI], 6.90 - 7.34) per 1000 person-years vs 4.82 (95% CI, 4.72 - 4.91) per 1000 person-years among HIV-uninfected veterans. Risk for HF was increased in HIV-infected vs HIV-uninfected veterans (adjusted hazard ratio [HR], 1.81; 95% CI, 1.39 - 2.36), even among those without a CHD event or a diagnosis related to alcohol abuse or dependence before the incident HF event (adjusted HR, 1.96; 95% CI, 1.29 - 2.98).

The risk for HF was higher in HIV-infected veterans with a baseline HIV-1 RNA level of at least 500 copies/mL vs HIV-uninfected veterans (adjusted HR, 2.28; 95% CI, 1.57 - 3.32). However, the risk for HF in HIV-infected veterans with baseline and recent HIV-1 RNA levels of less than 500 copies/mL was comparable to that in HIV-uninfected veterans (adjusted HR, 1.10; 95% CI, 0.64 - 1.89; P < .001 for groups with high vs low HIV-1 RNA levels).

"Our data suggest that HIV infection is a risk factor for HF," the study authors write. "Ongoing viral replication is associated with a higher risk of developing HF."

Limitations of this study include inability to exclude subclinical CHD, diagnosis of HF based on International Classification of Diseases, Ninth Revision, codes, inability to assess the effect of specific antiretroviral drugs or adherence to medication therapy, lack of generalizability to women, and inability to distinguish between HF associated with systolic vs diastolic dysfunction.

"If HF is a major cardiovascular consequence of HIV infection rather than atherosclerotic heart disease, different approaches to manage such consequences are warranted," the study authors conclude. "Cardiovascular risk factor reduction and antiplatelet agents (eg, aspirin) are the mainstay in the management of atherosclerotic heart disease; however, these strategies, plus aggressive blood pressure control and the treatment of the HIV infection, may also be required to prevent development of HF in this population. The exact approach would depend on the mechanism and mediators of this risk; therefore, further studies are needed."

Funding for the Veterans Aging Cohort Study was provided by a grant from the National Institute on Alcohol Abuse and Alcoholism and Veterans Health Administration Public Health Strategic Health Core Group; a grant from the National Heart, Lung, and Blood Institute; and a grant from the National Institute on Aging. The views expressed in the journal article are those of the study authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs. The study authors have disclosed no relevant financial relationships.

Arch Intern Med. 2011;171:737-743. Abstract