Abstract
Background: Highly active anti-retroviral therapy has transformed human immunodeficiency virus (HIV) infection into a chronic disease. HIV+ patients now experience increased mortality from chronic conditions such as heart failure (HF). Nonetheless, limited data has been published on the implementation of advanced HF therapies among this patient population. The aim of our study is to assess current disparities in therapies among HIV+ patients. Methods: We performed a retrospective analysis using the National Inpatient Database (NIS) from 2011 to 2018 to identify patients admitted for HF exacerbation. Patients were stratified according to HIV status. Baseline characteristics and clinical status were recorded. Primary outcome was implementation of advanced HF therapies (left ventricular assist device, LVAD and/or transplantation, HTX). Multivariate analysis models were adjusted for statistically significant differences in baseline characteristics between the groups. Results: A total of 39,527,306 HF patients were identified, of these 207,394 (0.52%) were HIV+. HF/HIV+ patients were less likely to be females (33.6% vs 49.8%, p < 0.001) and obese (11.6% vs 19.1%, p < 0.001). The prevalence of renal disease (50.9% vs 40.1%, p < 0.001) and dialysis dependance (19.7% vs. 5.2%, p < 0.001) was higher among the HF/HIV+ patients. The use of mechanical circulatory support was lower among HF/HIV+ (0.5% vs 0.7%, p < 0.001), despite higher incidences of cardiogenic shock (1.9% vs 1.8%, p = 0.001) among these patients. HF/HIV+ were less likely to go for LVAD (n=65, 0% vs n=2997, 0.1%, OR = 0.245, p < 0.001) or HTX (n=55, 0% vs n=21,089, 0.1%, OR = 0.266, p < 0.001). Conclusions: Access to advanced HF therapies among patients with HIV-associated cardiomyopathy appears to be limited and unequal. These results should encourage further studies to evaluate the short- and long-term clinical outcomes of advanced HF therapies among HF/HIV+ patients.
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