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HIV Infection and the Risk of World Health Organization-Defined Sudden Cardiac Death.

Matthew S Freiberg1,2,3,4, Meredith S Duncan1,5, Charles Alcorn6

  • 1Division of Cardiovascular Medicine Vanderbilt University Medical Center Nashville TN.

Journal of the American Heart Association
|September 8, 2021
PubMed
Summary

People living with HIV face higher sudden cardiac death (SCD) risks, especially with low CD4 counts or high viral loads. HIV infection independently elevates SCD risk, underscoring the need for careful cardiac monitoring in affected individuals.

Keywords:
CD4 cell countHIV infectionHIV viral loadsudden cardiac death

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Area of Science:

  • Cardiology
  • Infectious Diseases
  • Epidemiology

Background:

  • People living with HIV (PLWH) exhibit elevated rates of sudden cardiac death (SCD) compared to the general population.
  • The independent contribution of HIV infection to SCD risk remains incompletely understood.

Purpose of the Study:

  • To investigate whether HIV infection is an independent risk factor for World Health Organization (WHO)-defined sudden cardiac death (SCD).
  • To assess the association between HIV infection, CD4 cell counts, HIV viral load, and SCD risk.

Main Methods:

  • An observational, longitudinal cohort study utilizing data from the Veterans Aging Cohort Study.
  • Inclusion of 144,336 veterans (30% PLWH) matched 1:2 on demographics and clinical site, followed from 2003 to 2014.
  • Cox proportional hazards regression analysis to evaluate SCD risk associated with HIV status, CD4 counts, and viral load.

Main Results:

  • HIV infection was associated with an increased risk of SCD (HR, 1.14; 95% CI, 1.04-1.25), independent of confounders.
  • PLWH with CD4 counts <200 cells/mm³ or viral load >500 copies/mL showed significantly increased SCD risk.
  • PLWH with CD4 counts >500 cells/mm³ or viral load <500 copies/mL did not exhibit increased SCD risk.

Conclusions:

  • HIV infection is independently associated with an increased risk of WHO-defined SCD.
  • Elevated HIV viral load and low CD4 cell counts are key factors contributing to increased SCD risk in PLWH.
  • These findings highlight the importance of managing viral load and CD4 counts for cardiovascular risk reduction in PLWH.