Clinical Outcomes and Survival of HIV Positive and Negative Patients on LVAD Support

Abstract

<h3>Purpose</h3> HIV-infected (HIV+) patients have limited surgical options for treatment of end-stage heart failure due to the perceived risk of adverse events and insufficient data on clinical outcomes. The purpose of this study is to investigate post-implantation survival and adverse events for HIV+ patients compared with non-HIV infected (HIV-) patients on LVAD support. <h3>Methods</h3> We performed a retrospective data analysis of 22,065 patients from the STS Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) database who received an LVAD from January 2012 through June 2020. <h3>Results</h3> Compared with 21,980 HIV- LVAD recipients, the 85 HIV+ recipients were younger (median age 58 years vs. 59 years, p = 0.02), had lower BMI (26 kg/m² vs 29 kg/m², p = 0.001), and had higher rates of prior stroke (8% vs 4%, p=0.02), hepatitis (13% vs 1%, p <0.001) and illicit drug use (22% vs 9%, p <0.001). Overall, there was no significant difference in survival of HIV+ patients compared to HIV- patients at 1-year (79% vs 84%, p = 0.15) or 2-years (74% vs 78%, p = 0.29) post-implantation. In the 2 years post-implantation the hazard ratio for mortality was 1.14 (70% CI: 0.92-1.40, p = 0.52) for HIV+ patients compared with their non-infected counterparts (Figure 1). There was no significant difference in rates of post-implantation stroke, major bleeding, and VAD-related or non-VAD related infections by HIV infection status. Rates of rehospitalizations for fluid overload was significantly higher in the HIV+ patients (IRR: 1.16, p <0.01), however rehospitalizations for all other causes were not significantly different. <h3>Conclusion</h3> Despite higher rates of pre-implant comorbidities, there was no significant difference in mortality, stroke, major bleeding, or infection in HIV+ LVAD recipients compared to their HIV- counterparts. For HIV+ patients without access to transplantation, LVAD therapy should be offered as a safe, reliable option to manage end-stage heart failure.