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Human Immunodeficiency Virus Increases the Risk of Incident Heart Failure

Yen, Yung-Feng MD, MPH, PhD*,†,‡; Ko, Ming-Chung MD, PhD†,§; Yen, Muh-Yong MD*,‡; Hu, Bor-Shen MD*; Wang, Teng-Ho MD*; Chuang, Pei-Hung PhD; Lai, Hsin-Hao MD*; Chen, Chu-Chieh PhD; Deng, Chung-Yeh MD, ScD

JAIDS Journal of Acquired Immune Deficiency Syndromes: March 1, 2019 - Volume 80 - Issue 3 - p 255–263
doi: 10.1097/QAI.0000000000001917
Epidemiology
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Background: Although the HIV can cause myocardial inflammation, the association of HIV infection with subsequent development of heart failure (HF) has not been extensively studied. This nationwide cohort study aimed to determine the risk of incident HF in people living with HIV/AIDS (PLWHA).

Methods: We identified PLWHA using the Taiwan Centers for Disease Control and Prevention HIV Surveillance System. An age- and sex-matched control group without HIV infection was selected from the Taiwan National Health Insurance Research Database for comparison. All patients were followed up until December 2014 and were observed for a new diagnosis of HF. A time-dependent Cox proportional hazards model was used to determine the association of HIV and highly active antiretroviral therapy with incident HF, with death as a competing risk event.

Results: Of the 120,765 patients (24,153 PLWHA and 96,612 matched controls), 641 (0.53%) had incident HF during a mean follow-up period of 5.84 years, including 192 (0.79%) PLWHA and 449 (0.46%) controls. Time to diagnosis of incident HF was significantly shorter in PLWHA than in those without HIV infection (P < 0.001, the log-rank test). After adjusting for age, sex, and comorbidities, HIV infection was found to be an independent risk factor for incident HF (adjusted hazard ratio, 1.52; 95% confidence interval: 1.27 to 1.82). As the duration of highly active antiretroviral therapy increased, the risk of HF decreased (P = 0.014).

Conclusions: HIV infection was an independent risk factor for incident HF. Clinicians need to be aware of the higher risk of HF in PLWHA.

*Section of Infectious Diseases, Department of Internal Medicine, Taipei City Hospital, Taipei, Taiwan;

Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan;

Institute of Public Health, National Yang-Ming University, Taipei, Taiwan;

§Department of Urology, Taipei City Hospital, Taipei, Taiwan;

Taipei Association of Health and Welfare Data Science, Taipei, Taiwan; and

Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan.

Correspondence to: Chung-Yeh Deng, MD, ScD, Institute of Hospital and Health Care Administration, National Yang-Ming University, 155, Section 2, Ni-Long Street, Taipei 11221, Taiwan (e-mail: cydeng@ym.edu.tw).

Supported by a grant from the Department of Health, Taipei City Government, Taiwan.

The authors have no funding or conflicts of interest to disclose.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.jaids.com).

Received July 27, 2018

Accepted October 26, 2018

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