HIV Infection and the Risk of World Health Organization–Defined Sudden Cardiac Death
Background People living with HIV have higher sudden cardiac death (SCD) rates compared with the general population. Whether HIV infection is an independent SCD risk factor is unclear. Methods and Results This study evaluated participants from the Veterans Aging Cohort Study, an observational, longi...
| Main Authors: | , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2021-09-01
|
| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.121.021268 |
| _version_ | 1827958629111693312 |
|---|---|
| author | Matthew S. Freiberg Meredith S. Duncan Charles Alcorn Chung‐Chou H. Chang Suman Kundu Asri Mumpuni Emily K. Smith Sarah Loch Annie Bedigian Eric Vittinghoff Kaku So‐Armah Priscilla Y. Hsue Amy C. Justice Zian H. Tseng |
| author_facet | Matthew S. Freiberg Meredith S. Duncan Charles Alcorn Chung‐Chou H. Chang Suman Kundu Asri Mumpuni Emily K. Smith Sarah Loch Annie Bedigian Eric Vittinghoff Kaku So‐Armah Priscilla Y. Hsue Amy C. Justice Zian H. Tseng |
| author_sort | Matthew S. Freiberg |
| collection | DOAJ |
| description | Background People living with HIV have higher sudden cardiac death (SCD) rates compared with the general population. Whether HIV infection is an independent SCD risk factor is unclear. Methods and Results This study evaluated participants from the Veterans Aging Cohort Study, an observational, longitudinal cohort of veterans with and without HIV infection matched 1:2 on age, sex, race/ethnicity, and clinical site. Baseline for this study was a participant's first clinical visit on or after April 1, 2003. Participants were followed through December 31, 2014. Using Cox proportional hazards regression, we assessed whether HIV infection, CD4 cell counts, and/or HIV viral load were associated with World Health Organization (WHO)–defined SCD risk. Among 144 336 participants (30% people living with HIV), the mean (SD) baseline age was 50.0 years (10.6 years), 97% were men, and 47% were of Black race. During follow‐up (median, 9.0 years), 3035 SCDs occurred. HIV infection was associated with increased SCD risk (hazard ratio [HR], 1.14; 95% CI, 1.04–1.25), adjusting for possible confounders. In analyses with time‐varying CD4 and HIV viral load, people living with HIV with CD4 counts <200 cells/mm3 (HR, 1.57; 95% CI, 1.28–1.92) or viral load >500 copies/mL (HR, 1.70; 95% CI, 1.46–1.98) had increased SCD risk versus veterans without HIV. In contrast, people living with HIV who had CD4 cell counts >500 cells/mm3 (HR, 1.03; 95% CI, 0.90–1.18) or HIV viral load <500 copies/mL (HR, 0.97; 95% CI, 0.87–1.09) were not at increased SCD risk. Conclusions HIV infection is associated with increased risk of WHO‐defined SCD among those with elevated HIV viral load or low CD4 cell counts. |
| first_indexed | 2024-04-09T15:39:23Z |
| format | Article |
| id | doaj.art-03ed5716a1694e13be8917816733d94e |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-09T15:39:23Z |
| publishDate | 2021-09-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-03ed5716a1694e13be8917816733d94e2023-04-27T11:12:16ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802021-09-01101810.1161/JAHA.121.021268HIV Infection and the Risk of World Health Organization–Defined Sudden Cardiac DeathMatthew S. Freiberg0Meredith S. Duncan1Charles Alcorn2Chung‐Chou H. Chang3Suman Kundu4Asri Mumpuni5Emily K. Smith6Sarah Loch7Annie Bedigian8Eric Vittinghoff9Kaku So‐Armah10Priscilla Y. Hsue11Amy C. Justice12Zian H. Tseng13Division of Cardiovascular Medicine Vanderbilt University Medical Center Nashville TNDivision of Cardiovascular Medicine Vanderbilt University Medical Center Nashville TNDepartment of Biostatistics Graduate School of Public Health University of Pittsburgh PADepartment of Medicine University of Pittsburgh School of Medicine Pittsburgh PADivision of Cardiovascular Medicine Vanderbilt University Medical Center Nashville TNDivision of Cardiovascular Medicine Vanderbilt University Medical Center Nashville TNDivision of Cardiovascular Medicine Vanderbilt University Medical Center Nashville TNDivision of Cardiovascular Medicine Vanderbilt University Medical Center Nashville TNMasterClass San Francisco CADepartment of Epidemiology and Biostatistics University of California at San Francisco CADivision of General Internal Medicine Boston University Boston MADivision of Cardiology University of California San Francisco San Francisco CAVeterans Affairs Connecticut Health Care System West Haven Veterans Administration Medical Center West Haven CTCardiac Electrophysiology Section, Division of Cardiology University of California San Francisco San Francisco CABackground People living with HIV have higher sudden cardiac death (SCD) rates compared with the general population. Whether HIV infection is an independent SCD risk factor is unclear. Methods and Results This study evaluated participants from the Veterans Aging Cohort Study, an observational, longitudinal cohort of veterans with and without HIV infection matched 1:2 on age, sex, race/ethnicity, and clinical site. Baseline for this study was a participant's first clinical visit on or after April 1, 2003. Participants were followed through December 31, 2014. Using Cox proportional hazards regression, we assessed whether HIV infection, CD4 cell counts, and/or HIV viral load were associated with World Health Organization (WHO)–defined SCD risk. Among 144 336 participants (30% people living with HIV), the mean (SD) baseline age was 50.0 years (10.6 years), 97% were men, and 47% were of Black race. During follow‐up (median, 9.0 years), 3035 SCDs occurred. HIV infection was associated with increased SCD risk (hazard ratio [HR], 1.14; 95% CI, 1.04–1.25), adjusting for possible confounders. In analyses with time‐varying CD4 and HIV viral load, people living with HIV with CD4 counts <200 cells/mm3 (HR, 1.57; 95% CI, 1.28–1.92) or viral load >500 copies/mL (HR, 1.70; 95% CI, 1.46–1.98) had increased SCD risk versus veterans without HIV. In contrast, people living with HIV who had CD4 cell counts >500 cells/mm3 (HR, 1.03; 95% CI, 0.90–1.18) or HIV viral load <500 copies/mL (HR, 0.97; 95% CI, 0.87–1.09) were not at increased SCD risk. Conclusions HIV infection is associated with increased risk of WHO‐defined SCD among those with elevated HIV viral load or low CD4 cell counts.https://www.ahajournals.org/doi/10.1161/JAHA.121.021268CD4 cell countHIV infectionHIV viral loadsudden cardiac death |
| spellingShingle | Matthew S. Freiberg Meredith S. Duncan Charles Alcorn Chung‐Chou H. Chang Suman Kundu Asri Mumpuni Emily K. Smith Sarah Loch Annie Bedigian Eric Vittinghoff Kaku So‐Armah Priscilla Y. Hsue Amy C. Justice Zian H. Tseng HIV Infection and the Risk of World Health Organization–Defined Sudden Cardiac Death Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease CD4 cell count HIV infection HIV viral load sudden cardiac death |
| title | HIV Infection and the Risk of World Health Organization–Defined Sudden Cardiac Death |
| title_full | HIV Infection and the Risk of World Health Organization–Defined Sudden Cardiac Death |
| title_fullStr | HIV Infection and the Risk of World Health Organization–Defined Sudden Cardiac Death |
| title_full_unstemmed | HIV Infection and the Risk of World Health Organization–Defined Sudden Cardiac Death |
| title_short | HIV Infection and the Risk of World Health Organization–Defined Sudden Cardiac Death |
| title_sort | hiv infection and the risk of world health organization defined sudden cardiac death |
| topic | CD4 cell count HIV infection HIV viral load sudden cardiac death |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.121.021268 |
| work_keys_str_mv | AT matthewsfreiberg hivinfectionandtheriskofworldhealthorganizationdefinedsuddencardiacdeath AT meredithsduncan hivinfectionandtheriskofworldhealthorganizationdefinedsuddencardiacdeath AT charlesalcorn hivinfectionandtheriskofworldhealthorganizationdefinedsuddencardiacdeath AT chungchouhchang hivinfectionandtheriskofworldhealthorganizationdefinedsuddencardiacdeath AT sumankundu hivinfectionandtheriskofworldhealthorganizationdefinedsuddencardiacdeath AT asrimumpuni hivinfectionandtheriskofworldhealthorganizationdefinedsuddencardiacdeath AT emilyksmith hivinfectionandtheriskofworldhealthorganizationdefinedsuddencardiacdeath AT sarahloch hivinfectionandtheriskofworldhealthorganizationdefinedsuddencardiacdeath AT anniebedigian hivinfectionandtheriskofworldhealthorganizationdefinedsuddencardiacdeath AT ericvittinghoff hivinfectionandtheriskofworldhealthorganizationdefinedsuddencardiacdeath AT kakusoarmah hivinfectionandtheriskofworldhealthorganizationdefinedsuddencardiacdeath AT priscillayhsue hivinfectionandtheriskofworldhealthorganizationdefinedsuddencardiacdeath AT amycjustice hivinfectionandtheriskofworldhealthorganizationdefinedsuddencardiacdeath AT zianhtseng hivinfectionandtheriskofworldhealthorganizationdefinedsuddencardiacdeath |