Adjudicated Heart Failure in HIV-Infected and Uninfected Men and Women

Background-HIV is associated with elevated risk of heart failure (HF). Despite poor agreement between automated, administrative code-based HF definitions and physician-adjudicated HF, no studies have evaluated incident adjudicated HF for people living with HIV (PLWH). Methods and Results-We analyzed PLWH and uninfected controls receiving care in an urban medical system from January 1, 2000, to July 12, 2016. Physicians reviewed data from medical records to adjudicate HF diagnoses. We used multivariable-adjusted Cox models to analyze incident HF for PLWH versus controls and HIV-related factors associated with incident HF. We also analyzed the performance of automated versus physician-adjudicated HF definitions. Incident adjudicated HF occurred in 97 of 4640 PLWH (2.1%; mean: 6.8 years to HF) and 55 of 4250 controls (1.3%; mean: 6.7 years to HF; multivariable-adjusted hazard ratio: 2.10; 95% confidence interval, 1.38-3.21). Among PLWH, higher HIV viral load (hazard ratio per log(10) higher time-updated viral load: 1.22; 95% confidence interval, 1.11-1.33) was associated with greater HF risk and higher CD4+ T cell count was associated with lower HF risk (hazard ratio per 100 cells/mm(3) higher time-updated CD4 count: 0.80; 95% confidence interval, 0.69-0.92). In exploratory analyses, the most accurate automated HF definitions had sensitivities of 67% to 75% and positive predictive values of 54% to 60%. Conclusions-In a cohort with rigorous HF adjudication, PLWH had greater risks of HF than uninfected people after adjustment for demographics and cardiovascular risk factors. Higher HIV viral load and lower CD4+ T cell count were associated with higher HF risk among PLWH. Automated methods of HF ascertainment exhibited poor accuracy for PLWH and uninfected people.