Multicenter study of heart failure phenotypes and physician-adjudicated etiologies in people with HIV.

Abstract

Background: Limited systematic data exist on HF phenotypes in contemporary HIV care, and no prior multicenter studies have investigated physician-adjudicated phenotypes and etiologies of HF in PWH.

Methods: We adjudicated HF events and sub-phenotypes occurring between January 1, 2010 and December 31, 2021 at two large urban clinical centers within the CFAR Network of Integrated Clinical Systems (CNICS) cohort. Using Cox proportional hazard regression, hazard ratios were calculated to examine associations of HIV-specific and cardiometabolic risk factors with incident HF among PWH. Exploratory analyses investigated presence of physician-adjudicated ischemic and non-ischemic etiologies of HF.

Results: Of 402 individuals with events screened as possible HF, 289 were adjudicated as HF. Of these 289, 77 were prevalent at baseline and 212 were incident. Higher viral load and lower CD4 T cell count were associated with incident HF. In addition, older age, smoking, hypertension, diabetes mellitus, history of myocardial infarction (MI), and renal insufficiency were associated with higher HF risk. Nonischemic HF etiologies were more common than ischemic, and HF with reduced ejection fraction (HFrEF) was more common than preserved ejection fraction (HFpEF). Despite distinct demographic and risk factor compositions between the two sites, HF phenotypes were similar.

Conclusion: HIV viremia, low CD4 T cell count, traditional CVD risk factors, and renal insufficiency were associated with higher risk for HF. The predominant HF subtype was non-ischemic HF. While further studies are needed, our findings suggest HF prevention and management in PWH will require addressing complex interactions between HIV-related and traditional CVD risk factors.