HIV Patients at Higher Risk of Developing Heart Failure

Risk is not associated with cardiovascular events such as heart attacks, Kaiser Permanente researchers report.

In the U.S. and many other countries, HIV/AIDS has gone from being an acute illness with a high mortality rate to a chronic condition that can be successfully managed with antiviral therapy. Now researchers are getting a better understanding of the long-term consequences of the disease.

A prime example is HIV and heart disease. A study has found that patients with HIV are nearly 70% more likely of developing heart failure than people without HIV and the increased risk doesn’t appear to be related to cardiovascular events such as heart attacks.

“Our study suggests that other factors should be investigated, including possible direct effects of HIV on the heart, HIV-associated inflammation, or negative effects of therapies used to treat HIV,” says Michael J. Silverberg, Ph.D., M.P.H., research scientist and HIV epidemiologist at the Kaiser Permanente Division of Research, who was senior author on the paper, published in December 2021 in the journal Mayo Clinic Proceedings.

Silverberg and his colleagues identified nearly 40,000 people with HIV who were Kaiser Permanente members between the years 2000 and 2016 in one of three regions: Northern California, Southern California, and the mid-Atlantic. They matched each person with up to 10 Kaiser Permanente members from the corresponding region who were the same age, gender, and race but did not have HIV and identified the people in both groups who had developed heart failure during follow-up.

They found that people with HIV had a 68% higher risk of developing heart failure compared with people without HIV and showed the risk was higher in people who were under 40, women, and those of Asian or Pacific Islander heritage.

“Heart failure is a large and growing public health burden, especially among older adults, that is linked to lower survival and poorer quality of life,” says first author Alan S. Go, M.D., senior research scientist at the Kaiser Permanente Division of Research. “Previous research focused primarily on the higher risk of heart attack and stroke in people with HIV. However, little was known about whether people with HIV are at higher risk for developing heart failure and, if so, whether it is primarily because they have more coronary heart disease, a higher burden of cardiovascular risk factors, or differential use of preventive medications.”

There are ways to limit the risk, Go says. For instance, those with HIV could be screened for cardiovascular risk factors and have them aggressively treated through a comprehensive approach of healthy diet choices, greater physical activity, stopping tobacco use, avoiding drugs and other substances, and appropriate use of medications to optimize heart health.

“Also, starting HIV medications immediately after an HIV diagnosis can help reduce inflammation and risk of cardiovascular disease,” he says. “Our study highlights why physicians who treat patients with HIV should be aware of the symptoms of heart failure so that a diagnostic workup and early intervention can be expedited, particularly in people with HIV who are younger, women, or of Asian or Pacific Islander heritage.”