Association of human immunodeficiency virus with acute myocardial infarction and presumed sudden cardiac death

Background: While extensive evidence linking human immunodeficiency virus (HIV) infection to acute myocardial infarction (AMI), several studies have also suggested an association between HIV and presumed sudden cardiac death (PSCD). Our objective was to evaluate the association between HIV and PSCD compared to AMI. Understanding whether HIV confers differential risks for distinct cardiovascular outcomes is essential to guide prevention strategies and risk stratification in this population. Methods: The study design was a case-control study. We combined data from the large prospective population-based Paris Sudden Death Expertise Center Registry on PSCD and from the French National Health Insurance (SNDS) database. The SNDS database contains comprehensive data on all reimbursements for health-related expenditures and detailed medical information on all admissions to French public and private hospitals. In this study, adult patients with PSCD that occurred between 2011 and 2020 in Paris and the 3 adjacent departments were matched with AMI controls. We identified HIV patients in the 2 populations. We used a logistic regression to estimate the association between HIV and PSCD compared to HIV and AMI, adjusted for confounders. Results: In this study, 22,510 PSCD patients (60% men, age 71 (17) years) were matched with 22,510 AMI controls (60% men, age 72 (17) years). Among them, 245 (1%) and 104 (1%) had a positive HIV status preceding PSCD and AMI respectively. The odds of PSCD was 97% higher than the odds of AMI in HIV patients (adjusted odds-ratio, 1.97; 95% confidence interval: 1.55-2.49) Conclusions: Our findings, based on big data analysis, strongly suggest a significant association between HIV status and PSCD, also among patients without a history of AMI. The underlying mechanisms still remain incompletely defined and further studies are needed.