Cardiac Catheterization Procedures in Patients with HIV: A Retrospective Analysis.

Bertrand Ebner,Jelani Grant,Louis Vincent,Claudia Martinez

doi:10.3390/jcdd8040033

Abstract

With the advent of effective antiretroviral therapies, there has been a decrease in HIV-related mortality, but an increase in non-AIDS-related comorbidities including cardiovascular disease (CVD). We sought to investigate current status of cardiac catheterization (CC) procedures in people with HIV (PWH). This is a retrospective study done at a University Hospital in South Florida between 2017 and 2019. Medical records from 985 PWH indicated that CC was performed in 1.9% of the cases. Of the PWH who underwent CC, 68% were found to have obstructive coronary artery disease (CAD). Among obstructive CAD cases, PCI was performed in 77% and CABG in 21% of cases; 26% had a repeat procedure and 11% died from non-cardiac causes. When comparing PWH who had CC to those who did not, there was a significantly higher rate of statin use (63% vs. 25%, p < 0.015) and a higher prevalence of low ejection fraction (38% vs. 11%, p = 0.004) among those patients who underwent CC. However, there was no significant difference in the prevalence of hypertension (p = 0.13), HbA1c levels (p = 0.32), CD4 count (p = 0.45) nor in undetectable viral load status (p = 0.75) after controlling for age, sex and BMI. Despite the finding of traditional CVD risk factors among PWH, there were no differences in HIV-related factors among patients requiring CC, supporting the importance of optimization of traditional CVD risk factors in this population.

Highlights

In recent years, both the efficacy and availability of antiretroviral medication therapy for human immunodeficiency virus (HIV) infection has improved dramatically
Investigations suggest that persons living with HIV (PWH) with just one risk factor for coronary artery disease (CAD) may have a two-fold increased risk of acute myocardial infarction (MI) [9]
The majority of subjects self-identified as African American (AA)/Black (65.4%), while 33.4% identified as White, and 1% identified as other races

Summary

Introduction

Both the efficacy and availability of antiretroviral medication therapy for human immunodeficiency virus (HIV) infection has improved dramatically. The past two decades have seen an increase in life expectancy of persons living with HIV (PWH) [1] These changes have led to a decrease in HIV-related conditions, but a rise in non-AIDS-related comorbidities, most notably cardiovascular diseases (CVD) [2]. Investigations suggest that PWH with just one risk factor for coronary artery disease (CAD) may have a two-fold increased risk of acute myocardial infarction (MI) [9]. This increased risk rises to 3.6-fold in PWH with three or more CAD risk factors, compared to HIV-seronegative patients [10]. PWH with acute MI carry a 4.6-fold increased risk of repeat MI at one year follow-up, with a 4.5-fold increased risk for sudden cardiac death compared to the general population [11,12]

Methods

Results

Conclusion