MedicalResearch.com Interview with:
Matthew S Freiberg, MD, MSc
Associate Professor of Medicine, Division of Cardiovascular Medicine
Vanderbilt Translational and Clinical Cardiovascular Research Center
MedicalResearch.com: What is the background for this study?
Response: HIV infected people are living longer and are at risk for cardiovascular diseases. While acute myocardial infarction has been studied and the increased risk of Acute Myocardial Infarction (AMI) among HIV+ people compared to uninfected people is well documented, there are less data describing the risk of HIV and different types of heart failure, including reduced and preserved ejection fraction heart failure. Understanding more about the link between HIV and different types of HF is important because reduced and preserved ejection fraction heart failure differ with respect to underlying mechanism, treatment, and prognosis. Moreover, as cardiovascular care has improved, HIV infected people who experience an AMI are likely to survive but may live with a damaged heart. Understanding more about the link between HIV and heart failure may help providers and their patients prevent or reduce the impact of HF on the HIV community.
MedicalResearch.com: What are the main findings?
Response: HIV infection is associated with both reduced ejection fraction HF (HFrEF) and preserved ejection fraction HF (HFpEF). The risk of HFrEF was pronounced in young people (those who were 40 years old or less at baseline in this study); and that low CD4 cell count was associated with both HFrEF and HFpEF. Although the underlying mechanism driving this risk of HF is not known, the fact that time updated low CD4 cell count was associated with both types of heart failure suggests that duration of HIV infection and by extension, chronic inflammation, T cell activation, and loss of adaptive immunity may all play an important role.
MedicalResearch.com: What should readers take away from your report?
Response: Our findings have important implications for HIV+ people and their health care providers. Providers should focus on guideline recommended HIV treatment, HF risk factor prevention including diabetes, hypertension, renal disease, smoking, alcohol abuse and dependence, and obesity; and screening for HIV with new onset heart failure where appropriate. Developing tools designed to risk stratify HIV+ people for HF will also be required.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: I think there is a need for basic and translational science research focusing on elucidating the underlying mechanism(s) causing this excess risk of HFrEF and HFpEF among HIV+ people.
MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.
Freiberg MS, Chang CH, Skanderson M, Patterson OV, DuVall SL, Brandt CA, So-Armah KA, Vasan RS, Oursler KA, Gottdiener J, Gottlieb S, Leaf D, Rodriguez-Barradas M, Tracy RP, Gibert CL, Rimland D, Bedimo RJ, Brown ST, Goetz MB, Warner A, Crothers K, Tindle HA, Alcorn C, Bachmann JM, Justice AC, Butt AA. Association Between HIV Infection and the Risk of Heart Failure With Reduced Ejection Fraction and Preserved Ejection Fraction in the Antiretroviral Therapy EraResults From the Veterans Aging Cohort Study. JAMA Cardiol. Published online April 05, 2017. doi:10.1001/jamacardio.2017.0264
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