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Increased Sudden Cardiac Death Rate Among HIV Patients

 May 16, 2012 Viewed: 691

Patients with HIV/AIDS have a significantly increased risk of sudden cardiac death (SCD), according to a study published in the May 22 issue of the Journal of the American College of Cardiology.

Zian H. Tseng, M.D., of the University of California in San Francisco, and associates conducted a retrospective study of 2,860 HIV patients treated at a public HIV clinic in San Francisco from April 2000 to August 2009. Data were collected on deaths, cause of death, and clinical characteristics, and the link between HIV/AIDS and SCD was investigated.

During a median follow-up of 3.7 years, the researchers identified 230 deaths. Of these, 57 percent were due to AIDS; 14 percent met the criteria for SCD; 11 percent were due to natural causes; and 19 percent were due to overdoses, suicides, and unknown causes. Eighty-six percent of the cardiac deaths (30 of 35) were due to SCD. The mean SCD rate was 4.5-fold higher than expected, at 2.6 per 1,000 person-years. Compared with AIDS deaths, SCD occurred in older patients (49.0 versus 44.9 years; P = 0.02). SCDs had a significantly higher prevalence of prior myocardial infarction, cardiomyopathy, heart failure, and arrhythmia than AIDS and natural deaths combined.

“SCDs account for most cardiac and many non-AIDS natural deaths in HIV-infected patients,” the authors write. “Further investigation is needed to ascertain underlying mechanisms, which may include inflammation, antiretroviral therapy interruption, and concomitant medications.”

One author disclosed a financial relationship with Biotronik.

Abstract

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Patients with HIV/AIDS have a significantly increased risk of sudden cardiac death, according to a study published in the May 22 issue of the Journal of the American College of Cardiology.

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Sudden Cardiac Death in Patients With Human Immunodeficiency Virus Infection Results: Of 230 deaths over a median of 3.7 years of follow-up, 30 (13%) met SCD criteria, 131 (57%) were due to acquired immune deficiency syndrome (AIDS), 25 (11%) were due to other (natural) diseases, and 44 (19%) were due to overdoses, suicides, or unknown causes. SCDs accounted for 86% of all cardiac deaths (30 of 35). The mean SCD rate was 2.6 per 1,000 person-years (95% confidence interval: 1.8 to 3.8), 4.5-fold higher than expected. SCDs occurred in older patients than did AIDS deaths (mean 49.0 vs. 44.9 years, p = 0.02). Compared with AIDS and natural deaths combined, SCDs had a higher prevalence of prior myocardial infarction (17% vs. 1%, p < 0.0005), cardiomyopathy (23% vs. 3%, p < 0.0005), heart failure (30% vs. 9%, p = 0.004), and arrhythmias (20% vs. 3%, p = 0.003). Conclusions: SCDs account for most cardiac and many non-AIDS natural deaths in HIV-infected patients. Further investigation is needed to ascertain underlying mechanisms, which may include inflammation, antiretroviral therapy interruption, and concomitant medications. Zian H. Tseng, MD, MAS, Eric A. Secemsky, MD, David Dowdy, MD, PhD, ScM, Eric Vittinghoff, PhD, MPH, Brian Moyers, MD, Joseph K. Wong, MD||, Diane V. Havlir, MD and Priscilla Y. Hsue, MD

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