Key result
Although atrial fibrillation and flutter were more common among HIV-infected persons compared to uninfected controls (2.00% vs 1.57%, OR 1.27), this difference was attenuated after adjustment for demographics and cardiovascular risk factors.
Why the study?
No prior studies have compared atrial fibrillation and atrial flutter prevalence and characteristics between HIV-infected persons and matched uninfected controls.
Is HIV infection associated with an increased prevalence of atrial fibrillation and atrial flutter compared to matched uninfected controls?
Cross-Sectional (n=15,173)
No
Is HIV infection associated with an increased prevalence of atrial fibrillation and atrial flutter compared to matched uninfected controls?
Odds Ratio: 1.27 (95% CI 0.99–1.64)
Absolute Event Rate: 2% vs 1.57%
p-value: p=0.056
While overall AF/AFL prevalence was not significantly higher in HIV+ persons after adjusting for demographics and risk factors, severe HIV-related immunosuppression (nadir CD4 <200 cells/mm3) was associated with a twofold elevated odds of AF/AFL.
Low nadir CD4 count was associated with higher AF/AFL odds among HIV+ persons; leaves open whether immunosuppression independently elevates arrhythmia risk.
BACKGROUND: Human Immunodeficiency Virus-Infected (HIV+) persons have elevated risks for various manifestations of cardiovascular disease (CVD). No studies to our knowledge have compared atrial fibrillation (AF) and atrial flutter (AFL) prevalence and associated characteristics for HIV+ persons and matched uninfected controls. METHODS AND FINDINGS: Persons with diagnoses of HIV receiving care at a large urban academic medical center were frequency-matched 1:2 on age, sex, race, zip code, and clinic location with uninfected persons. Possible AF/AFL was screened for using administrative codes and diagnoses of AF/AFL were subsequently adjudicated using electrocardiography and physician notes; adjudication was performed given the inconsistent validity of administrative code-derived AF diagnoses found in previous studies. There were 101 confirmed AF/AFL cases (2.00%) among 5,052 HIV+ patients and 159 confirmed AF/AFL cases (1.57%) among 10,121 uninfected controls [Odds Ratio (OR) 1.27, 95% Confidence Interval (CI) 0.99-1.64; p = 0.056]. The association between HIV serostatus and AF/AFL was attenuated after adjustment for demographics and CVD risk factors. Among HIV+ persons, nadir CD4+ T cell count <200 cells/mm3 was associated with approximately twofold elevated odds of AF/AFL even after adjustment for demographics and CVD risk factors (Multivariable-adjusted OR 1.98, 95% CI 1.21-3.25). There was no significant association between log10 of peak HIV viral load and AF/AFL (Multivariable-adjusted OR 1.03, 95% CI 0.86-1.24). Older age, diabetes, hypertension, and chronic obstructive pulmonary disease were associated with similarly elevated odds of AF/AFL for HIV+ persons and uninfected controls. CONCLUSION: HIV-related immunosuppression (nadir CD4 T cell count <200 cells/mm3) and traditional CVD risk factors are associated with significantly elevated odds of AF/AFL among HIV+ persons. Although atrial fibrillation and flutter was more common among HIV+ versus uninfected persons in this cohort, this difference was attenuated by adjustment for demographics and CVD risk factors.
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Sanders et al. (2018) conducted a cross-sectional in Human Immunodeficiency Virus (HIV) infection (n=15,173). HIV infection vs. Uninfected controls was evaluated on Physician-adjudicated atrial fibrillation or atrial flutter (AF/AFL) (OR 1.27, 95% CI 0.99-1.64, p=0.056). Although atrial fibrillation and flutter were more common among HIV-infected persons compared to uninfected controls (2.00% vs 1.57%, OR 1.27), this difference was attenuated after adjustment for demographics and cardiovascular risk factors.
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