HIV Infection Linked to Heart Failure Risk in Kaiser Study

Kerry Dooley Young

December 15, 2021

People with HIV infection appeared more likely to develop heart failure than those without it, especially those who were younger than 40, female, or of Asian or Pacific Islander ancestry, according to a study drawn from electronic medical records in the giant Kaiser Permanente system.

The rate of incident heart failure for the group with HIV infection was 0.23 per 100 person-years vs 0.15 for those without HIV, reported Alan S. Go, MD, a senior research scientist at Kaiser Permanente's Division of Research, and co-authors. The study was published online December 13 in Mayo Clinic Proceedings.

Go and colleagues used data from within Kaiser Permanente's system to track how often people with HIV infection developed heart failure. They looked at data for 38,868 people with HIV infection and a matched set of 386,586 people who did not have HIV.

Go told Medscape Medical News that the research team found 448 cases of heart failure among the group with HIV infection, and 3492 in the matched group. (This means that roughly 1 person in 87 in the HIV group developed heart failure, compared with 1 in 111 for the matched group, by Medscape's calculations.)

There was actually a higher prevalence of risk factors for cardiovascular disease among those without HIV. For example, in the group with HIV infection, 6.9% of those studied had hypertension compared with 11.7% of those who did not have the infection. This highlights the need for further study of the cause of this risk, Go said.

"There's a real need to identify both HIV-specific risk factors as well as other things that may contribute to the higher risk of heart failure," Go said. "We have to do more to figure out those specific mechanisms" that could cause this difference.

Closer Watch for Heart-Failure Symptoms

People with HIV and their physicians should be aware of signs of early heart failure such as shortness of breath, fatigue, leg swelling, coughing, and chest pain, urged Go and co-author Michael J. Silverberg, PhD, MPH, a Kaiser Permanente research scientist and HIV epidemiologist.

"HIV patients often receive all of their care in busy HIV primary care clinics, and it is possible that signs and symptoms of heart failure may be missed, resulting in delays in treatment," said Silverberg in a statement.

The findings in the Kaiser Permanente study build on earlier work that identified higher cardiovascular risk for people with HIV infection, including research done with records comparing veterans' health records.

A 2017 study published in JAMA Cardiology reported that people included in the Veterans Aging Cohort Study (VACS) who had HIV infection had an increased risk of heart failure, compared with people who did not have the infection. This study examined the medical histories of 66,492 veterans who were not infected with HIV and 31,523 who were infected with HIV.

In a 2020 paper in JACC: Heart Failure , Sebhat Erqou, MD, PhD, and co-authors reported that veterans who had HIV infections and heart failure had higher risk of hospitalization and mortality compared with counterparts who did not have this infection. Their research drew from records for patients with heart failure who were treated within the Veterans Health Administration.

In an interview, Erqou noted the lessons that could be drawn from Kaiser Permanente's more diverse pool of patients. Like Go, Erqou said the findings of the Kaiser Permanente researchers should draw attention to heart failure as a risk for patients for whom clinicians might not suspect this illness.

The research done in veterans tended to skew toward male and older subjects. The mean age at enrollment in the VACS study was 48.3 years and 97% of those studied were male. The mean age of the pool of patients studied by the Kaiser Permanente team was 41.4 years, with males making up 87.7% of this group.

In looking at heart failure rates in different groups, Go and colleagues reported:

  • For women with HIV, the crude rate per 100 person-years for heart failure was 0.27, compared to 0.12 for those who did not have the infection.

  • For men, the rates for these groups were 0.23, compared to 0.16.

The researchers also concluded that:

  • For those of Asian or Pacific Islander heritage with HIV infection, the crude rate per 100 person-years of heart failure rate was 0.17, compared with 0.08 for those who did not have the infection. 

  • For white people, the rates were 0.25, compared to 0.16.

  • For Black people, the rates were 0.31, compared to 0.23.

  • For Hispanic people, the rates were 0.12, compared with 0.10.

Lastly, the investigators found that:

  • For people ages 21 to 40, the crude rate per 100 person-years for heart failure was 0.10 for those with HIV, compared to 0.04 for those who did not have the infection.

  • For those ages 41 to 50, the rates were 0.19 compared to 0.14.

  • For those ages 51 and older, the rates were 0.59 compared to 0.42.

This study was funded by the National Heart, Lung, and Blood Institute of the National Institutes of Health. The authors have disclosed no relevant financial relationships.

Mayo Clin Proc. Published online December 13, 2021. Abstract

Kerry Dooley Young is a freelance journalist based in Washington, DC. She is the core topic leader on patient safety issues for the Association of Health Care Journalists. Young earlier covered health policy and the federal budget for Congressional Quarterly/CQ Roll Call and the pharmaceutical industry and the Food and Drug Administration for Bloomberg. Follow her on Twitter at @kdooleyyoung.

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