Physicians' Academy for Cardiovascular Education

High risk of sudden cardiac death in HIV-positive persons with HF

The Risk for Sudden Cardiac Death Among Patients Living With Heart Failure and Human Immunodeficiency Virus

Literature - Alvi RM, Neilan AM, Tariq et al., - JACC Heart Fail. 2019 DOI: 10.1016/j.jchf.2019.04.025

Introduction and methods

Because patients with heart failure (HF) are at higher risk of sudden cardiac death (SCD), insertion of an implantable cardioverter-defibrillator is indicated [1]. Conventional indications for ICD for primary prevention of SCD in HF patients are imperfect. They may suggest the use of ICD in patients who are not likely to benefit, or fail to identify persons at risk of SCD [2,3]. Hence, better characterization of populations at risk may be of help.

Persons living with human immunodeficiency virus infection (PHIV) are at increased risk for HF [4], and SCD is increased among PHIV without HF [5]. No data are available on the risk for SCD among PHIV with HF. There are, however, epidemiological and pathophysiological data to support the hypothesis that the risk for SCD is increased among PHIV with HF, as compared with uninfected persons with HF [5-7]. This study set out to investigate the incidence of SCD among PHIV with HF and the risk factors associated with it, in an observational registry of all patients admitted with a primary diagnosis of acute decompensated HF. Patients having ICD’s or receiving one during follow-up were excluded from analysis. Follow-up started on the first date of discharge from the first HF hospitalization in 2011. Primary outcome was occurrence of SCD.

Main results


This study shows that PHIV with HF show a higher rate of SCD than uninfected control subjects with HF. Moreover, better HIV disease control measures, namely higher CD4 count and undetectable viral load, were associated with lower, but not background rates of SCD among PHIV. CAD, cocaine use, absence of beta-blockers, low LVEF and QRS width and corrected QT interval duration were predictors of SCD, also after stratifying the cohort based on LVEF.


Show references

Find this article online at JACC: Heart Failure

Share this page with your colleagues and friends: