Effect of Left Ventricular Dysfunction and Viral Load on Risk of Sudden Cardiac Death In Patients with Human Immunodeficiency Virus
ABSTRACT Human Immunodeficiency Virus-infected patients are disproportionately affected by cardiovascular disease and sudden cardiac death (SCD). Whether left ventricular (LV) dysfunction predicts SCD in those with human immunodeficiency virus (HIV) is unknown. We sought to determine the impact of LV on SCD in patients with HIV. We previously characterized all SCDs and AIDS deaths in2860 consecutive patients in a public HIV clinic between 2000 and 2009. Transthoracic echocardiograms (TTEs) performed during the study period were identified. The effect of ejection fraction (EF), diastolic dysfunction, pulmonary artery pressure, and LV masson SCD and acquired immune deficiency syndrome (AIDS) deathwere evaluated:423patients had at least one TTE; 13 SCDs and 55 AIDS deaths had at least one TTE. In the propensity-adjusted analysis, EF 30-39% and EF <30% predicted SCD (HR 9.5, 95% CI 1.7-53.3, p=0.01 and HR 38.5, 95% CI 7.6-195.0, p<0.001, respectively) but not AIDS death. Diastolic dysfunction also predicted SCD (HR 14.8, 95% CI 4.0-55.4, p<0.001) but not AIDS death, even after adjustingfor EF. The association between EF<40% and SCD was greater in subjects with detectable vs. undetectable HIV-RNA (adjusted HR 11.7, 95%CI 2.9-47.2, p=0.001 vs. HR 2.7, 95%CI 0.3-27.6, p=0.41; p=0.07 for interaction).In conclusion, LV systolic and diastolic dysfunction predict SCD but not AIDS death in a large HIV cohort, with greater effect in those with detectable HIV RNA. Further investigation is needed to thoroughly evaluate the effect of low EF and HIV factors on SCD incidence and the potential benefit of implantable cardioverter-defibrillator therapy in this high-risk population.
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ABSTRACT: Patients infected with the human immunodeficiency virus (HIV) have an increased cardiovascular risk. Although initially this increased risk was attributed to metabolic alterations associated with antiretroviral treatment, in recent years, the attention has been focused on the HIV disease itself. Inflammation, immune system activation, and endothelial dysfunction facilitated by HIV infection have been identified as key factors in the development and progression of atherosclerosis. In this review, we describe the epidemiology and pathogenesis of cardiovascular disease in patients with HIV infection and summarize the latest knowledge on the relationship between traditional and novel inflammatory, immune activation, and endothelial dysfunction biomarkers on the cardiovascular risk associated with HIV infection.Vascular Health and Risk Management 01/2015; 11:35-48. DOI:10.2147/VHRM.S65885