Results:

Of the 394 persons with HIV with HF (47% female, mean age 60 ± 9.5 years, CD4 count 292 ± 206 cells/mm³), 145 (37%) were prescribed a protease inhibitor, whereas 249 (63%) were prescribed nonprotease inhibitor regimens. All protease inhibitor-based antiretroviral therapy contained boosted-dose ritonavir. Persons with HIV who were receiving a protease inhibitor had higher rates of dyslipidemia, diabetes mellitus, and coronary artery disease (CAD); higher pulmonary artery systolic pressure (PASP); and lower LVEF. In follow-up, protease inhibitor use was associated with increased CV mortality (35% vs. 17%; p < 0.001) and 30-day HF readmission (68% vs. 34%; p < 0.001), effects seen in all HF types.

Among the persons with HIV hospitalized with HFrEF, the CV mortality rate was higher among the individuals who were taking a protease inhibitor versus a nonprotease inhibitor (36% vs. 21%; p = 0.021). Among the persons with HIV hospitalized with HFpEF, the CV mortality rate was higher in the individuals taking a protease inhibitor versus a nonprotease inhibitor (33% vs. 15%; p = 0.004); and among the persons with HIV hospitalized with HFbEF, the CV mortality rate was also higher in the individuals who were taking a protease inhibitor versus a nonprotease inhibitor (35% vs. 4%; p = 0.01). Increased 30-day HF readmission rate with protease inhibitors were noted when groups were analyzed according to the type of HF: HFrEF with a protease inhibitor versus HFrEF not with a protease inhibitor (70% vs. 55%; p < 0.001); HFpEF with a protease inhibitor versus HFpEF with a nonprotease inhibitor (66% vs. 22%; p < 0.001); and HFbEF with a protease inhibitor versus HFbEF with an nonprotease inhibitor (65% vs. 23%; p = 0.01). Predictors of CV mortality included protease inhibitor use, CAD, PASP, and immunosuppression. Overall, protease inhibitors were associated with a twofold increased risk of CV mortality.