Advanced Heart Failure Therapy in HIV Positive Patients: Do These Patients Get Equal Treatment?

Abstract

Purpose More than 1 million Americans are currently infected with HIV. This study investigates the position of transplant centers towards advanced heart failure (HF) therapy in HIV+ pts. Methods and Materials A survey concerning heart transplant (HT) and LVAD implantation protocol and outcome in HIV+ pts was distributed to all American HT centers (103 in US, 8 in Canada). Results 79% (n=81) of US and 100% (n=8) of Canadian centers (100%) responded. A total of 18 HTs were performed in HIV+ pts with excellent outcome (1,3,10 years survival of 100%, 90%, 63%). 92% (n=82) of the centers never performed HT in HIV+ pts and 57% (n=51) marked HIV+ as a contraindication. The predominant rationales provided were: 1) high-risk pts should be avoided given the scarcity of organ supply (59%), 2) Immunosuppression required for HT may induce HIV progression to AIDS (51%) and 3) drug interactions may worsen prognosis (49%). 76% (n=68) have never conducted LVAD implantations in HIV+ pts and 20% marked HIV+ as a contraindication. Overall, 34 LVAD implantations in HIV+ pts were reported. 61% replied that a device-related infection in HIV+ is the most significant concern. Conclusions 1) Most centers either explicitly consider or de-facto treat HIV+ status as contraindication for advanced HF therapy. 2) Short life expectancy, transformation to AIDS, drug interaction and higher susceptibility to infection are the major concerns. 3) Clinical outcomes of OHT and LVAD implantation in HIV+ patients are similar to the general population. The cardiology community is still not ready to indiscriminately offer advanced HF therapy to these pts. This negative position may prevent some HIV pts, who are otherwise good candidates, from receiving adequate advanced HF therapy. [ figure 1 ]