Abstract 11608: Characteristics of Incident Heart Failure in HIV Disease at an Urban HIV Clinic and Hospital From 2007-2014

Abstract

Introduction: HIV is an independent risk factor for coronary artery disease and the prevalence of subclinical systolic and diastolic abnormalities are greater than expected for age. However, less is known regarding the incidence and pattern of acute heart failure syndrome (HF) among contemporary HIV-positive patients. Methods: We performed a retrospective analysis of HIV-positive patients presenting with incident HF from 2007-2014. All patients with ICD-9 diagnoses for HIV and HF were selected and further adjudicated for incident HF based on symptoms, physical findings, biomarkers, and imaging studies. Clinical characteristics and echocardiographic findings were described, and subgroup comparisons were explored based on HIV viral suppression. Results: Among 2703 HIV-positive patients, 74 had a diagnosis of HF (prevalence of 2.7%), of which 28 were adjudicated incident HF (annual incidence of 0.15%). Patients with incident HF were younger (median age 50 yr.), predominantly male (75%), and African American (68%). The median duration of HIV infection prior to heart failure was 11 years with the majority (75%) on HAART (39% receiving a protease inhibitor) with a median CD4+ cell count of 295 cells/mm 3 . The major comorbid conditions include hypertension (82%), history of substance abuse (64%), and diabetes (32%). Table-1 presents the transthoracic echocardiographic findings for all incident HF patients. The mean ejection fraction (EF) for virally suppressed (HIV RNA <200 copies/ml) patients was 45.3% as opposed to 31.8 % for those unsuppressed. Conclusion: Incident HF among urban HIV-positive patients occurs at younger age when compared to the rates of the uninfected in the general population, with a significant proportion presenting with preserved EF. Future research should focus on whether HF syndrome in HIV disease shifts from predominantly systolic dysfunction, to a pattern similar in the general population, particularly among the virally suppressed.