title: Risk of heart failure with human immunodeficiency virus in the absence of prior diagnosis of coronary heart disease.
abstract: BACKGROUND
  Whether human immunodeficiency virus (HIV) infection is a risk factor for heart failure (HF) is not clear. The presence of coronary heart disease and alcohol consumption in this population may confound this association.
  
  
  METHODS
  To determine whether HIV infection is a risk factor for incident HF, we conducted a population-based, retrospective cohort study of HIV-infected and HIV-uninfected veterans enrolled in the Veterans Aging Cohort Study Virtual Cohort (VACS-VC) and the 1999 Large Health Study of Veteran Enrollees (LHS) from January 1, 2000, to July 31, 2007.
  
  
  RESULTS
  There were 8486 participants (28.2% HIV-infected) enrolled in the VACS-VC who also participated in the 1999 LHS. During the median 7.3 years of follow-up, 286 incident HF events occurred. Age- and race/ethnicity-adjusted HF rates among HIV-infected and HIV-uninfected veterans were 7.12 (95% confidence interval [CI], 6.90-7.34) and 4.82 (95% CI, 4.72-4.91) per 1000 person-years, respectively. Compared with HIV-uninfected veterans, those who were HIV infected had an increased risk of HF (adjusted hazard ratio [HR], 1.81; 95% CI, 1.39-2.36). This association persisted among veterans who did not have a coronary heart disease event or a diagnosis related to alcohol abuse or dependence before the incident HF event (adjusted HR, 1.96; 95% CI, 1.29-2.98). Compared with HIV-uninfected veterans, those who were HIV infected with a baseline Human immunodeficiency virus 1 (HIV-1) RNA level of 500 or more copies/mL had a higher risk of HF (adjusted HR, 2.28; 95% CI, 1.57-3.32), while those with baseline and a recent HIV-1 RNA level less than 500 copies/mL did not (adjusted HR, 1.10; 95% CI,  0.64-1.89; P < .001 for comparison between high and low HIV-1 RNA groups).
  
  
  CONCLUSIONS
  Our data suggest that HIV infection is a risk factor for HF. Ongoing viral replication is associated with a higher risk of developing HF.
authors.affiliation: Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA. aabutt@pitt.edu
authors.forename: Adeel A
authors.initials: AA
authors.lastname: Butt
authors.forename: Chung-Chou
authors.initials: CC
authors.lastname: Chang
authors.forename: Lewis
authors.initials: L
authors.lastname: Kuller
authors.forename: Matthew Bidwell
authors.initials: MB
authors.lastname: Goetz
authors.forename: David
authors.initials: D
authors.lastname: Leaf
authors.forename: David
authors.initials: D
authors.lastname: Rimland
authors.forename: Cynthia L
authors.initials: CL
authors.lastname: Gibert
authors.forename: Krisann K
authors.initials: KK
authors.lastname: Oursler
authors.forename: Maria C
authors.initials: MC
authors.lastname: Rodriguez-Barradas
authors.forename: Joseph
authors.initials: J
authors.lastname: Lim
authors.forename: Lewis E
authors.initials: LE
authors.lastname: Kazis
authors.forename: Stephen
authors.initials: S
authors.lastname: Gottlieb
authors.forename: Amy C
authors.initials: AC
authors.lastname: Justice
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Freiberg
mesh_terms: D000328:Adult; D015897:Comorbidity; D003327:Coronary Disease / Q000175:diagnosis; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology; D006333:Heart Failure / Q000453:epidemiology* / Q000821:virology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D014728:Veterans / Q000706:statistics & numerical data*