Abstract
Introduction: Women with HIV have an increased risk of incident heart failure (HF). Whether HF outcomes differ by HIV status in women has not been established. Methods: We performed a US health care system-based cohort study analyzing data from 1388 HIV-infected women initially matched 1:10 on age, race/ethnicity with uninfected women. The presence of HF was ascertained by ICD-9-CM codes and adjudicated by physicians blinded to HIV status. After adjudication, cohorts were re-matched 1:3 so that age, race/ethnicity would be similar in the final cohort. The primary outcome was incident HF hospitalization rate. Secondary outcomes included HF hospitalization length of stay, all cause and cardiovascular mortality. Results: The final HF cohort consisted of 34 HIV-infected and 102 uninfected women (mean age 59 years). There were no significant differences in the LVEF (54±15 vs. 52±14%, HIV+ vs. HIV-, p=0.48) or prevalence of HFrEF (EF<50%) (29 vs. 35%, HIV+ vs. HIV-, p=0.67). HIV-infected women with HF had more cocaine use (23 vs. 6%, p=0.006), lower BMI (28±5 vs. 33±8 kg/m 2 , p=0.002), increased QRS (113±19 vs. 97±20 msec, p <0.0001) and higher PASP (49±10 vs. 35±10 mmHg, p<0.0001). Over a median follow-up of 5 years (IQR 4.0-7.5), HIV-infected women with HF had 2.5 times the rate of incident HF hospitalization, adjusted for age, HTN, DM, sleep apnea, CAD, ACE I/ARB and LVEF (HR: 2.5 (1.54-4.29), p<0.0001) (Figure). HIV-infected women with HF also had an increased HF hospitalization length of stay (8 vs. 5 days, p<0.001), and higher all-cause (53 vs. 21%, p<0.001) and cardiovascular mortality (83 vs. 33%, p<0.006). In sub-group analysis, HIV-infected women with HFrEF had lower use of guideline-recommended HF therapy (40 vs. 83%, p=0.01). Conclusions: As compared with matched uninfected women with HF, HIV-infected women with HF had a lower use of HF therapies, increased HF hospitalization rate, HF hospitalization length of stay, and all-cause and cardiovascular mortality.
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