HIV Linked to Increased Heart Failure Risk

People with HIV, especially those with detectable viral load, were found to be at increased risk of heart failure in a study of U.S. veterans.

People living with HIV are known to have higher than normal rates of heart disease. The role that HIV infection itself plays in heart disease tends to be confounded by several factors, including higher than average rates of smoking and alcohol abuse among people with HIV, as well as the possible role some antiretroviral drugs may play in heart disease. As the population of people living with HIV in the U.S. ages, HIV's impact on heart disease becomes increasingly important. The roles that both HIV and its treatment play in heart disease require more research.

To further understand the role that HIV infection plays in a person's risk of heart failure, Adeel Butt and colleagues evaluated the rates of heart failure in a cohort of 8486 people, of whom 2391 (28%) were living with HIV. The results were report in the April 25, 2011 issue of the Archives of Internal Medicine.

The authors analyzed retrospective data from the Veterans Aging Cohort Study Virtual Cohort (VACS-VC) and the 1999 Large Health Study of Veteran Enrollees (LHS), looking at the period January 1, 2000 to July 31, 2007.

The average age in this cohort was 48 years, and about 40% were African American. The average follow-up period was 7.3 years. Although the researchers did not provide details about the sex of participants, VA cohorts tend to be overwhelmingly male.

While the HIV positive and negative groups were well matched in most ways there were some noteworthy differences as well. Nearly 3 times as many people in the HIV positive group were hepatitis C virus (HCV) positive. People living with HIV had higher rates of reported smoking and cocaine use in this study, but lower rates of hypertension and diabetes.

Results

• There were 286 cases of heart failure during the study: 97 among HIV positive people and 189 among HIV negative participants.
• The rate of heart failure was 7.12 per 1000 person-years for HIV positives, compared to 4.82 per 1000 person-years for HIV negatives.
• People with HIV had 1.81 times higher risk of heart failure compared to HIV negatives (about an 80% increase).
• People with HIV who had no prior cardiovascular disease or alcohol abuse diagnosis had 1.96 times higher risk of heart failure.
• Compared to HIV negatives, people with HIV and viral load > 500 copies/mL had a 2.28 times higher risk of heart failure.
• However, heart failure rates for people with HIV who had undetectable viral load were similar to those of HIV negatives (adjusted hazard ratio 1.10).
• Traditional risk factors such as smoking, hypertension, obesity, age, and African American race were found to increase the risk of heart failure across both groups.
• CD4 T-cell count was not a significant risk factor, and HIV positive people at all CD4 levels had an increased risk of heart failure.

"Our data suggest that HIV infection is a risk factor for heart failure," the authors of this study concluded. "Ongoing viral replication is associated with a higher risk of developing heart failure.
They elaborated in their article, "…HIV infection is associated with an increased risk of heart failure after adjusting for traditional risk factors for heart failure. This association persisted even after exclusion of patients with a baseline history of coronary heart disease, heart failure and angina, as well as a coronary heart disease event in the follow-up period prior to the diagnosis of heart failure and a history of alcohol abuse or dependence diagnosis."

This study is important in 2 ways. First, the finding that HIV infection itself, regardless of other risk factors, puts a person at increased risk of heart failure should emphasize the importance of cardiovascular health in the management of HIV disease. Second, this study's finding that people on effective antiretroviral therapy are able to normalize their risk of heart failure is likely to add to the arguments for earlier and more widespread HIV treatment.

Investigator affiliations: Departments of Medicine, University of Pittsburgh School of Medicine and Veterans Affairs (VA) Pittsburgh Healthcare System, Pittsburgh, PA; VA Greater Los Angeles Healthcare System and the David Geffen School of Medicine at the University of California, Los Angeles, CA; VA Medical Center and Emory University School of Medicine, Atlanta, GA; VA Medical Center and George Washington University, Washington, DC; University of Maryland School of Medicine and VA Maryland Healthcare System, Baltimore, MD; Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, TX; Yale University School of Medicine and Public Health, New Haven, CT; University of Maryland School of Medicine and Baltimore VA Medical Center, Baltimore, MD; VA Connecticut Healthcare System, West Haven, CT; Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA; Center for the Assessment of Pharmaceutical Practices, Department of Health Policy and Management, Boston University School of Public Health, Boston, MA.

4/29/11

Reference
AA Butt, CC Chang, L Kuller, et al. Risk of heart failure with human immunodeficiency virus in the absence of prior diagnosis of coronary heart disease. Archives of Internal Medicine 171(8):737-743 (abstract). April 25, 2011.