Heart failure and adverse heart failure outcomes among persons living with HIV in a US tertiary medical center

被引:21
作者
Alvi, Raza M. [1 ,2 ,3 ]
Afshar, Mohammad [3 ]
Neilan, Anne M. [4 ,5 ]
Tariq, Noor [6 ]
Hassan, Malek [1 ,2 ]
Gerber, Jaime [6 ]
Awadalla, Magid [1 ,2 ]
Mulligan, Connor P. [1 ,2 ]
Rokicki, Adam [1 ,2 ]
Triant, Virginia A. [7 ,8 ]
Zanni, Markella, V [9 ,10 ]
Neilan, Tomas G. [1 ,2 ]
机构
[1] Harvard Med Sch, Cardiac MR PET CT Program, Dept Radiol, Massachusetts Gen Hosp, Boston, MA 02115 USA
[2] Harvard Med Sch, Massachusetts Gen Hosp, Div Cardiol, Boston, MA 02115 USA
[3] Icahn Sch Med Mt Sinai, Dept Internal Med, Div Cardiol, Bronx Lebanon Hosp Ctr, Bronx, NY USA
[4] Harvard Med Sch, Div Infect Dis, Dept Med, Massachusetts Gen Hosp, Boston, MA 02115 USA
[5] Harvard Med Sch, Dept Pediat, Massachusetts Gen Hosp, Boston, MA 02115 USA
[6] Yale Univ, Yale New Haven Hosp, Sch Med, New Haven, CT 06520 USA
[7] Harvard Med Sch, Massachusetts Gen Hosp, Div Gen Internal Med, Boston, MA 02115 USA
[8] Harvard Med Sch, Massachusetts Gen Hosp, Div Infect Dis, Boston, MA 02115 USA
[9] Harvard Med Sch, Massachusetts Gen Hosp, Program Nutr Metab, Div Gen Internal Med, Boston, MA 02115 USA
[10] Harvard Med Sch, Massachusetts Gen Hosp, Program Nutr Metab, Div Infect Dis, Boston, MA 02115 USA
基金
美国国家卫生研究院;
关键词
CORONARY-ARTERY-DISEASE; ANTIRETROVIRAL THERAPY; PULMONARY-HYPERTENSION; MYOCARDIAL-INFARCTION; CLINICAL-TRIALS; COCAINE USE; INFECTION; ASSOCIATION; HEALTH; RISK;
D O I
10.1016/j.ahj.2019.01.002
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background Persons living with HIV (PLHIV) have an increased risk of heart failure (HF). However, little is known about outcomes among PLHIV with HF. The study aim was to compare HF outcomes among PLHIV with HF versus individuals without HIV with HF. Methods Our cohort included 2,308 individuals admitted with decompensated HF. We compared baseline characteristics, 30-day HF readmission, and cardiovascular (CV) and all-cause mortality. Within PLHIV, we assessed outcomes stratified between CD4 count and viral load (VL), and tested the association between traditional and HIV-specific parameters with 30-day HF readmission. Results There were 374 (16%) PLHIV with HF. Among PLHIV, 92% were on antiretroviral therapy and 63% had a VL <200 copies/mL. Groups were similar with respect to age, sex, race/ethnicity, and CV risk factors. In follow-up, PLHIV had increased 30-day HF readmission (49% vs 32%) and CV (26% vs 13.5%) and all-cause mortality rates (38% vs 22%). Among PLHIV, cocaine use, HIV-specific parameters (CD4, VL), and coronary artery disease were predictors of 30-day HF readmission. Specifically, among PLHIV, those with detectable VL had higher 30-day HF readmission and CV mortality, whereas PLHIV with undetectable VL had a similar 30-day HF readmission rate and CV mortality to uninfected controls with HF. Similar outcomes were observed across strata of left ventricular ejection fraction and by CD4. Conclusions PLHIV with a low CD4 count or detectable VL have an increased 30-day HF readmission rate as well as increased CV and all-cause mortality. In contrast, PLHIV with a higher CD4 count and undetectable VL have similar HF outcomes to uninfected controls.
引用
收藏
页码:39 / 48
页数:10
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