Cardiac Catheterization in Patients Living With Human Immunodeficiency Virus

Background: Since the advent of HIV therapy, there has been a decrease in HIV-related mortality, but an increase in non-AIDS-related comorbidities including cardiovascular disease (CVD). Previous studies suggested that patients living with HIV (PWH) underwent fewer cardiac procedures including cardiac catheterization (CC), compared to the general population. This finding is paradoxical because CVD risk is now known to be greater among PWH. We sought to investigate the prevalence and characteristics of PWH that underwent CC. Methods: This is a retrospective study of 985 PWH adults from the Special Immunology clinic at Jackson Memorial Hospital/University of Miami Hospital between 2017-2019. Data on demographics, clinical, laboratory and diagnostic studies were obtained from electronic health records. Results: The mean (SD) age of the cohort was 52 ± 12 years, and 55% were men. Medical records indicated that CC was performed in 1.9% of the PWH. The indications for CC included abnormal stress test (47.4%) and acute coronary syndrome (31.4%). Of the PWH who underwent CC, 68% were found to have obstructive coronary artery disease (CAD), mostly single-vessel disease (54%) and most commonly affecting the left anterior descending artery (50%). Among obstructive CAD cases, PCI was performed in 77% and CABG in 21% of cases. Drug-eluting stent was used in 67% of obstructive CAD findings. Of the PWH that had CC, 26% had a repeat procedure and 11% died from non-cardiac causes. When compared PWH who had CC to those who did not, there was a significantly higher rate of statin use (63% vs. 25%, p<0.015) and a higher prevalence of low ejection fraction (38% vs. 11%, p=0.004) among those patients who underwent CC. However, there was no significant difference in the prevalence of hypertension (p=0.130), HbA1c levels (p=0.317), CD4 count (p=0.454) nor in undetectable viral load status (p=0.752) after controlling for age, sex and BMI. Conclusion: This study found a higher rate of CC procedures among PWH than what was previously reported as well as a higher prevalence of obstructive CAD requiring PCI. In this study, despite the finding of traditional CVD risk factors among PWH, there were no differences in HIV-related factors among those who had and not CC, supporting the importance of optimization of traditional CVD risk factors in this population.