Infectious Disease

HIV leads to increased rates of sudden cardiac death, myocardial fibrosis

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Tseng does not report any relevant financial information. Please refer to the study for all relevant financial information from the other authors.

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Compared to people without HIV, HIV-positive people had higher rates of sudden cardiac death and myocardial fibrosis, and one-third of sudden cardiac death in people with HIV was due to an overdose of occult medication, researchers reported.

“In the current study, we attempted to determine the underlying causes of all suspected sudden cardiac deaths and the exact frequency of sudden cardiac death from arrhythmia in HIV-positive individuals and to compare these data with those of the nationwide population with no known HIV infection. “Zian H. Tseng, MD, cardiac electrophysiologist and professor of medicine at the University of California, San Francisco, and colleagues wrote in the New England Journal of Medicine.

The data was provided by Tseng TH et al. N Engl J Med. 2021; doi: 10.1056 / NEJMoa1914279.

For the HIV-POST-SCD study, from February 2011 to September 2016, researchers identified all new deaths from cardiac arrest outside of the hospital in San Francisco County in people ages 18 to 90 with or without HIV infection. Extensive autopsy, toxicological and histological tests were performed, and the researchers compared the rates of sudden cardiac death and sudden death from arrhythmia.

The prospective post-mortem study included 109 deaths from out-of-hospital cardiac arrest in people with HIV, of which 48 met WHO criteria for presumed sudden cardiac death. Of the 48 deaths, 22 were caused by irregular heartbeat. From February 2011 to March 2014, 505 suspected sudden cardiac deaths occurred in people without HIV.

According to the researchers, the incidence of suspected sudden cardiac death was 53.3 deaths per 100,000 person-years in people with HIV and 23.7 deaths per 100,000 person-years in people without HIV (incidence RR = 2.25; 95% CI, 1.37- 3.7). . In addition, the incidence of sudden death from arrhythmia was 25 deaths per 100,000 person-years in people with HIV and 13.3 deaths per 100,000 person-years in people without HIV (incidence RR = 1.87; 95% CI 0.93-3, 78).

The researchers also found that among people who had suffered sudden cardiac death, occult drug overdoses were more common in people with HIV than in people without HIV (34% versus 13%).

Tseng and colleagues found higher histological scores for interstitial myocardial fibrosis in people with HIV compared to people without HIV (average percentage of fibrosis 12.5% ​​vs. 8.7% in patients with suspected sudden cardiac death; 13.8% vs. 9.7 % in patients with death from those arrhythmias; 11.3% vs. 7% in those with death from non-arrhythmic causes).

“In this prospective nationwide autopsy of all deaths attributable to cardiac arrest outside the hospital, we found a higher incidence of suspected sudden cardiac death in people with known HIV infection than in people with no known HIV infection,” the researchers wrote. “Interstitial myocardial fibrosis was also more pronounced in HIV-positive people.”

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