Tight Control of HIV Associated With Lower Heart Failure Risk

HIV is known as an independent risk factor for heart failure; however, the association of HIV severity with incident heart failure and the potential interaction with sex are incompletely understood.

A group of researchers within three Kaiser Permanente systems have found that patients with HIV have an increased risk for heart failure, especially those with low CD4 counts and high RNA level.

The findings, published in the Journal of Acquired Immune Deficiencies Syndromes, suggest that optimizing HIV treatment and management may be important for prevention of heart failure among those with HIV.

The researchers conducted a retrospective cohort study in adults (≥21 years old) who were members of Kaiser Permanente integrated health care delivery systems in Northern California, Southern California, and the mid-Atlantic states (Maryland, Virginia, Washington, D.C.) between 2000 and 2016.

Michael A. Horberg, M.D.

“Kaiser Permanente provides comprehensive inpatient and outpatient services to a diverse patient population demographically representative of the general insured population in its service areas,” explained one of the investigators, Michael A. Horberg, director of HIV/AIDS program-wide for Kaiser Permanente and Clinical Lead for HIV/AIDS for the Care Management Institute.

Kaiser Permanente's electronic health record was used to identify people with HIV, and researchers matched them to people without HIV. Incident heart failure was found using a previously validated electronic health record coding system, Horberg said. Rates were determined for heart failure by sex and adjusted by other demographic and HIV-related factors. All analyses were done by both sexes combined, then stratified by sex.

Higher incident heart failure risk was observed among people with HIV at all HIV RNA levels, with greater risk at higher HIV RNA levels. The excess risk associated with low CD4 counts and high HIV RNA was stronger among women than among men.

“The main takeaways are that control of HIV with viral suppression and rebounding of CD4 counts are needed to lower risk of heart failure among people with HIV,” Horberg said. “To me, the surprising elements was that any detectable viral load increased risk for heart failure among people with HIV. This shows, once again, how critical aggressive viral control is in HIV, not just for preventing the immediate effects of HIV but also longer term and less obvious risks.”

Horberg and his colleagues believe it’s important for physicians treating HIV to be aware that there is greater risk for heart failure if patients have even slightly more advanced or poorly controlled HIV infection, especially women. 

Horberg also said the study highlights the kind of research Kaiser Permanente can do because of its size. “This study once again shows the strength of large databases,” he said. “We have nearly 39,000 people with HIV and 387,000 matched nearly 10:1 to people without HIV. Most healthcare systems cannot produce such results.”