Hiv infection and the risk of world health organization–defined sudden cardiac death

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

doi:10.1161/JAHA.121.021268

Hiv infection and the risk of world health organization–defined sudden cardiac death

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

Research output: Contribution to journal › Article › peer-review

30 Scopus citations

Abstract

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.

Original language	English
Article number	e021268
Journal	Journal of the American Heart Association
Volume	10
Issue number	18
DOIs	https://doi.org/10.1161/JAHA.121.021268
State	Published - Sep 21 2021

Bibliographical note

Publisher Copyright:
© 2021 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Funding

This work was supported by National Institutes of Health grant HL126555 (Drs Tseng and Freiberg). VACS acknowledges the support of contracts AA020794, AA020790, AA020795, AA020799, and AA013566 from the National Institute on Alcohol Abuse and Alcoholism for this research. The views expressed in this article are those of the authors and do not necessarily reflect the position or policies of the Department of Veterans Affairs. Dr. Hsue received honoraria from Gilead and Merck unrelated to the study stopic. Has also received research grant from Novartis unrelated to the study topic.

Funders	Funder number
National Institutes of Health (NIH)	AA020790, HL126555, AA020795, AA020794, AA020799
National Institutes of Health (NIH)
National Institute on Alcohol Abuse and Alcoholism	U01AA013566
National Institute on Alcohol Abuse and Alcoholism
Novartis

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

CD4 cell count
HIV infection
HIV viral load
Sudden cardiac death

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine

Access to Document

10.1161/JAHA.121.021268

Cite this

Freiberg, M. S., Duncan, M. S., Alcorn, C., Chang, C. C. H., Kundu, S., Mumpuni, A., Smith, E. K., Loch, S., Bedigian, A., Vittinghoff, E., So-Armah, K., Hsue, P. Y., Justice, A. C., & Tseng, Z. H. (2021). Hiv infection and the risk of world health organization–defined sudden cardiac death. Journal of the American Heart Association, 10(18), Article e021268. https://doi.org/10.1161/JAHA.121.021268

@article{fb75434dd572436db6a527bc68516b66,

title = "Hiv infection and the risk of world health organization–defined sudden cardiac death",

abstract = "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{\textquoteright}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.",

keywords = "CD4 cell count, HIV infection, HIV viral load, Sudden cardiac death",

author = "Freiberg, \{Matthew S.\} and Duncan, \{Meredith S.\} and Charles Alcorn and Chang, \{Chung Chou H.\} and Suman Kundu and Asri Mumpuni and Smith, \{Emily K.\} and Sarah Loch and Annie Bedigian and Eric Vittinghoff and Kaku So-Armah and Hsue, \{Priscilla Y.\} and Justice, \{Amy C.\} and Tseng, \{Zian H.\}",

note = "Publisher Copyright: {\textcopyright} 2021 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.",

year = "2021",

month = sep,

day = "21",

doi = "10.1161/JAHA.121.021268",

language = "English",

volume = "10",

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}

Freiberg, MS, Duncan, MS, Alcorn, C, Chang, CCH, Kundu, S, Mumpuni, A, Smith, EK, Loch, S, Bedigian, A, Vittinghoff, E, So-Armah, K, Hsue, PY, Justice, AC & Tseng, ZH 2021, 'Hiv infection and the risk of world health organization–defined sudden cardiac death', Journal of the American Heart Association, vol. 10, no. 18, e021268. https://doi.org/10.1161/JAHA.121.021268

TY - JOUR

T1 - Hiv infection and the risk of world health organization–defined sudden cardiac death

AU - Freiberg, Matthew S.

AU - Duncan, Meredith S.

AU - Alcorn, Charles

AU - Chang, Chung Chou H.

AU - Kundu, Suman

AU - Mumpuni, Asri

AU - Smith, Emily K.

AU - Loch, Sarah

AU - Bedigian, Annie

AU - Vittinghoff, Eric

AU - So-Armah, Kaku

AU - Hsue, Priscilla Y.

AU - Justice, Amy C.

AU - Tseng, Zian H.

PY - 2021/9/21

Y1 - 2021/9/21

N2 - 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.

AB - 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.

KW - CD4 cell count

KW - HIV infection

KW - HIV viral load

KW - Sudden cardiac death

UR - https://www.scopus.com/pages/publications/85116569104

UR - https://www.scopus.com/pages/publications/85116569104#tab=citedBy

U2 - 10.1161/JAHA.121.021268

DO - 10.1161/JAHA.121.021268

M3 - Article

C2 - 34493058

AN - SCOPUS:85116569104

SN - 2047-9980

VL - 10

JO - Journal of the American Heart Association

JF - Journal of the American Heart Association

IS - 18

M1 - e021268

ER -

Hiv infection and the risk of world health organization–defined sudden cardiac death

Abstract

Bibliographical note

Funding

UN SDGs

Keywords

ASJC Scopus subject areas

Access to Document

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