HIV Tied to Higher Risk of Sudden Cardiac Death

By Marilynn Larkin

September 16, 2021

NEW YORK (Reuters Health) - HIV infection was associated with a greater risk of sudden cardiac death (SCD) in an observational study, especially among those with poor HIV disease control and/or a high burden of SCD risk factors.

"The important message is that people with HIV have an increased risk of cardiovascular diseases but this risk is less if the HIV infection is treated," Dr. Matthew Freiberg of Vanderbilt University Medical Center in Nashville told Reuters Health by email. "This is similar to what we have observed in other cohort studies for other cardiovascular diseases. Providers and patients should be aware of the risk and work to achieve successful HIV treatment while also preventing or treating other important risk factors that may increase the risk of SCD."

"One major limitation of this study, and nearly all other studies of SCD, is that the condition is hard to define and is rarely confirmed by autopsy," coauthor Dr. Zian Tseng of the University of California, San Francisco, noted in the same email. "Although we used meticulous methods to define SCD using the World Health Organization (WHO) definition, because very few of the SCDs we classified were verified by autopsy, misclassification of some of these WHO-defined SCDs cannot be excluded."

WHO defines SCD as "sudden unexpected death within 1 hour of symptom onset if witnessed or within 24 hours of being observed alive and symptom free (unwitnessed).

As reported in the Journal of the American Heart Association, the authors analyzed data on close to 145,000 veterans (mean baseline age, 50; 97% men; 47% African American) with and without HIV infection, matched on age, sex, race/ethnicity, and clinical site. Thirty percent were people living with HIV, and follow-up was a median of nine years.

A total of 3,035 SCDs occurred. After adjustment, HIV infection was associated with increased SCD risk (hazard ratio,1.14).

In analyses with time-varying CD4 counts and HIV viral load, people living with HIV with CD4 counts <200 cells/mm3 (HR, 1.57) or viral load >500 copies/mL (HR, 1.70) had increased SCD risk versus those without HIV.

In contrast, people living with HIV with CD4 cell counts >500 cells/mm3 (HR,1.03) or viral load <500 copies/mL (HR, 0.97) were not at increased SCD risk.

Dr. Jana Dickter, an associate clinical professor at City of Hope in Duarte, California, commented on the study in an email to Reuters Health, "In resource-rich settings, HIV care routinely includes initiating preventative interventions to help mitigate these risks, including treating hypertension, dyslipidemia, diabetes, and counseling on the importance of smoking cessation. This study emphasizes the importance of achieving viral suppression in persons infected with HIV with antiretroviral therapy and treating other cardiovascular risk factors in this population."

However, she noted, the study included a homogeneous demographic group so the findings may not be generalizable to more heterogenous populations. "Additionally," she said, "as certain antiretroviral medications have been associated with an increased risk of cardiovascular disease and dyslipidemia, determining if there were any differences in SCD in the HIV-treated group based on their antiretroviral regimen would have been an interesting addition."

Dr. Carlos Malvestutto, an associate professor at the Ohio State University Wexner Medical Center in Columbus also commented by email. "This study highlights another reason why it is so important to make HIV testing widely available so that people who may have been unaware of their status can be identified and started on antiretroviral therapy before their HIV disease becomes more advanced and their CD4 counts become severely depleted."

"It also shows us why it is provide the necessary support and services that people living with HIV require to remain adherent with their treatment and minimize the consequences of low CD4 counts and uncontrolled viremia," he said. "Most of our people living with HIV will not die of AIDS, but will likely die of heart disease, including SCD."

SOURCE: Journal of the American Heart Association, online September 8, 2021.