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Sudden Cardiac Death in Persons With HIV
Quick Takes
- Incidence rates of presumed sudden cardiac death were higher among HIV-positive persons than among those without known HIV infection.
- Among persons with presumed sudden cardiac death and sudden death from arrhythmia, the burden of total and interstitial myocardial fibrosis was higher among HIV-positive persons than among persons in the reference group.
- Occult drug overdoses were more than twice as common in the HIV-positive group compared to the reference group.
Study Questions:
What are the underlying causes of all presumed sudden cardiac deaths and the precise incidence of sudden death caused by arrhythmia in human immunodeficiency virus (HIV)-positive persons?
Methods:
The investigators prospectively identified all new deaths due to out-of-hospital cardiac arrest among persons 18-90 years of age, with or without known HIV infection between February 1, 2011, and September 16, 2016, for comprehensive autopsy and toxicologic and histologic testing. The authors compared the rates of sudden cardiac death and sudden death caused by arrhythmia between groups. Incidence rates according to HIV status, both overall and within subgroups according to age, sex, and race or ethnicity, were calculated using unadjusted Poisson regression models with robust standard errors, with numbers of deaths as the outcome and the log of person-years at risk as an offset.
Results:
Of 109 deaths from out-of-hospital cardiac arrest among 610 unexpected deaths in HIV-positive persons, 48 met World Health Organization criteria for presumed sudden cardiac death; of those, fewer than half (22) had an arrhythmic cause. A total of 505 presumed sudden cardiac deaths occurred between February 1, 2011, and March 1, 2014, in persons without known HIV infection. Observed incidence rates of presumed sudden cardiac death were 53.3 deaths per 100,000 person-years among persons with known HIV infection and 23.7 deaths per 100,000 person-years among persons without known HIV infection (incidence rate ratio, 2.25; 95% confidence interval [CI], 1.37-3.70). Observed incidence rates of sudden death caused by arrhythmia were 25.0 and 13.3 deaths per 100,000 person-years, respectively (incidence rate ratio, 1.87; 95% CI, 0.93-3.78). Among all presumed sudden cardiac deaths, death due to occult drug overdose was more common in persons with known HIV infection than in persons without known HIV infection (34% vs. 13%). Persons who were HIV-positive had higher histologic levels of interstitial myocardial fibrosis than persons without known HIV infection.
Conclusions:
The authors concluded that the rates of presumed sudden cardiac death and myocardial fibrosis were higher among HIV-positive persons than among those without known HIV infection.
Perspective:
This study reports that incidence rates of presumed sudden cardiac death were higher among HIV-positive persons than among those without known HIV infection. Furthermore, among persons with presumed sudden cardiac death and sudden death from arrhythmia, the burden of total and interstitial myocardial fibrosis was higher among HIV-positive persons than among persons in the reference group. Of note, occult drug overdoses were more than twice as common in the HIV-positive group compared to the reference group. There is a need for targeted substance abuse counseling for these high-risk patients as well as other measures to try to reduce sudden cardiac death in HIV patients.
Clinical Topics: Acute Coronary Syndromes, Arrhythmias and Clinical EP, Diabetes and Cardiometabolic Disease, Prevention, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias
Keywords: Acute Coronary Syndrome, Arrhythmias, Cardiac, Autopsy, Death, Sudden, Cardiac, Death, Sudden, Drug Overdose, Ethnic Groups, Fibrosis, HIV Infections, HIV-2, Metabolic Syndrome, Out-of-Hospital Cardiac Arrest, Secondary Prevention
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