Multicenter study of heart failure phenotypes and physician-adjudicated causes in people with HIV

Limited systematic data exist on heart failure phenotypes in contemporary HIV care, and no prior multicenter studies have investigated physician-adjudicated phenotypes and causes of heart failure in people with HIV (PWH).

We adjudicated heart failure events and sub-phenotypes occurring between January 1, 2010, and December 31, 2021, at two large urban clinical centers within the CFAR Network of Integrated Clinical Systems (CNICS) cohort. Using Cox proportional hazard regression, hazard ratios were calculated to examine associations of HIV-specific and cardiometabolic risk factors with incident heart failure among PWH. Exploratory analyses investigated presence of physician-adjudicated ischemic and nonischemic causes of HF.

Of 402 individuals with events screened as possible heart failure, 289 were adjudicated as heart failure. Of these 289, 77 were prevalent at baseline and 212 were incident. Higher viral load and lower CD4 +  T cell count were associated with incident heart failure. In addition, older age, smoking, hypertension, diabetes mellitus, history of myocardial infarction (MI), and renal insufficiency were associated with higher heart failure risk. Nonischemic heart failure causes were more common than ischemic, and heart failure with reduced ejection fraction (HFrEF) was more common than preserved ejection fraction (HFpEF). Despite distinct demographic and risk factor compositions between the two sites, heart failure phenotypes were similar.

HIV viremia, low CD4 +  T cell count, traditional CVD risk factors, and renal insufficiency were associated with higher risk for heart failure. The predominant heart failure subtype was nonischemic heart failure. While further studies are needed, our findings suggest heart failure prevention and management in PWH will require addressing complex interactions between HIV-related and traditional CVD risk factors.