Traditional and HIV-Specific Risk Factors Associated With Atrial Fibrillation Among Underrepresented Minority Groups...

Evaluation of nonvalvular atrial fibrillation/atrial flutter (NVAF) in under-represented racial and ethnic minority groups (UREGs) living with HIV has not been adequately studied.

The purpose of this study was to describe the incidence of NVAF, identify associated factors, and describe oral anticoagulation (OAC) patterns among UREGs with HIV.

This is a secondary analysis of data collected in PATHWAYS (Pathways to Cardiovascular Disease Prevention and Impact of Specialty Referral in Underrepresented Racial and Ethnic Minorities with HIV; NCT04025125), a retrospective population-based study of HIV care among UREGs with HIV. We investigated the independent associations of cardiovascular and HIV-specific risk factors with incident NVAF using Cox regression analysis and examined appropriate OAC use.

From 2015 to 2019, 11,066 UREGs with HIV met entry criteria; 10,945 were without NVAF at baseline. On average, patients were 44 years of age, 67.2% male, 94.4% Black, and 8.5% Hispanic. Average follow-up was 3.4 years, and 63.4% were on antiretroviral therapy. Incidence of NVAF was 4.54 incident cases per 1,000 person-years with a cumulative incidence at one and 5 years after HIV diagnosis of 0.48% and 2.16%, respectively. Age, diabetes, heart failure, severe renal disease, and antiretroviral therapy regimens including a protease inhibitor and/or integrase strand transfer inhibitor were independently associated with incident NVAF. Of those with NVAF meeting qualifying CHA₂DS₂-VASc scores, only 44.2% received any OAC prescription for stroke prophylaxis.

In this cohort of UREGs living with HIV, both traditional and HIV-specific risk factors were associated with incident NVAF. Rates of appropriate OAC prescribing were low.