Nashville, TN—For HIV patients, effective viral suppression and cardiovascular (CV) disease risk-factor modification are literally a matter of life-and-death, according to a new study.

Vanderbilt University School of Medicine–led researchers determined that HIV patients with sustained viremia or low CD4 cell counts had an excess risk of sudden cardiac death (SCD). They emphasized the importance of ensuring compliance with antiretroviral therapy, as well as providing guideline-based care for CV risk factors.

“People living with HIV are already known to have a higher risk of heart attack, stroke, heart failure, blood clots in the lungs and peripheral artery disease,” explained lead author Matthew S. Freiberg, MD, MSc, “We know that, among people with HIV, those who have a compromised immune system, for example a low total CD4+ T cell count, they seem to have a higher risk of cardiovascular disease than those who have high CD4+ T cell counts. It is unclear if a compromised immune system is a risk factor for sudden cardiac death.”

The study, which was published in the Journal of the American Heart Association, used data from the Veterans Aging Cohort Study, an observational, longitudinal cohort of veterans with and without HIV infection. Participants were matched 1:2 on age, sex, race/ethnicity, and clinical site.

Participants were followed from their first clinical visit in 2003 until the end of 2014. The study team assessed whether HIV infection, CD4 cell counts, and/or HIV viral load were associated with World Health Organization (WHO)–defined SCD risk.

HIV patients made up 30% of the 144,336 participants; the mean age was 50 years, 97% were men, and 47% were of black race. During follow-up of about 9 years, 3,035 SCDs occurred. The study concluded that HIV infection was associated with increased SCD risk (hazard ratio [HR], 1.14; 95% CI, 1.04-1.25), with adjustment for possible confounders.

“In analyses with time-varying CD4 and HIV viral load, people living with HIV with CD4 counts <200 cells/mm3 (HR, 1.57; 95% CI, 1.28-1.92) or viral load >500 copies/mL (HR, 1.70; 95% CI, 1.46-1.98) had increased SCD risk versus veterans without HIV. In contrast, people living with HIV who had CD4 cell counts >500 cells/mm3 (HR, 1.03; 95% CI, 0.90-1.18) or HIV viral load <500 copies/mL (HR, 0.97; 95% CI, 0.87-1.09) were not at increased SCD risk,” the authors reported.

After adjustment for age, sex, race/ethnicity, presence of heart or kidney disease, cocaine or alcohol dependence or abuse, and various heart disease risk factors, the researchers found that the risk of SCD was not increased in HIV patients who had healthy levels of infection-fighting CD4+ T cells or those who had a low level of HIV in their blood.

On the other hand, that risk was determined to be progressively higher with each risk factor for SCD that was present. Those included existing CV disease, high blood pressure, smoking, hepatitis C infection, anemia, alcohol dependence or abuse, and chronic obstructive pulmonary disease, regardless of whether the patient had HIV.

Still, the study reported that SCD was:

• 14% higher in particpants with HIV
• 57% higher in participants with HIV whose blood tests showed low levels of CD4+ T cells over time, an indicator that HIV was progressing and the immune system was compromised
• 70% higher in participants with HIV whose blood tests showed that antiretroviral therapy had not suppressed the HIV viral load in their blood over time.

The content contained in this article is for informational purposes only. The content is not intended to be a substitute for professional advice. Reliance on any information provided in this article is solely at your own risk.