Human Immunodeficiency Virus Infection and Incident Heart Failure: A Meta-Analysis of Prospective Studies

Objectives: To systematically analyze available prospective evidence on the association between HIV infection and incident heart failure (HF). Methods: A systematic search of PubMed, EMBASE, Web of Science, and manual search of relevant articles through June 1st, 2020, was conducted. Two authors independently performed full-text assessments and data extraction. The pooled relative risk with 95% confidence interval was estimated using DerSimonian and Laird random-effects models, with inverse-variance fixed-effects meta-analysis used as a sensitivity analysis. Heterogeneity was explored using subgroup analyses and meta-regressions. Results: We included 8 reports among 8,848,569 participants with 101,335 incident cases of HF [1941 among 131,632 people living with HIV (PLWH) and 99,394 among 8,716,937 control participants]. In the overall analysis using a random-effect model, HIV infection was positively associated with incident HF [relative risk, 1.80 (95% confidence interval: 1.51 to 2.15)], although with significant heterogeneity. A similar association was observed with a fixed-effects model, 1.59 (1.50 to 1.68). In subgroup analyses, associations between HIV infection and HF were nominally stronger in younger adults (age < 50 years), women, and individuals with low CD4 count (<200 cells/mm(3)). Publication bias was suggested from visual examination of funnel plots, correcting for this did not abolish the association, 1.52 (1.25 to 1.85). Conclusions: Our meta-analysis provides additional evidence that HIV is associated with an increased risk of HF, particularly among younger adults, women, and individuals with low CD4 count.