title: Advanced heart failure in patients infected with human immunodeficiency virus: is there equal access to care?
abstract: BACKGROUND
  Human immunodeficiency virus (HIV) infection has evolved from a highly stigmatized disease with certain progression to acquired immunodeficiency syndrome (AIDS) to a chronic disease affecting over 1 million Americans. With the success of current anti-retroviral therapies, cardiovascular disease, including advanced heart failure (HF), will be a major cause of morbidity and mortality in this population.
  
  
  METHODS
  A survey concerning heart transplantation (HT) and left ventricular assist device (LVAD) implantation attitudes and outcomes in HIV-infected patients was distributed to 103 American and 9 Canadian HT centers via fax, e-mail or telephone.
  
  
  RESULTS
  Eighty-nine centers (79%) responded. Eighteen HTs were performed in HIV(+) patients with 1-, 2- and 5-year survival of 100%, 100% and 63%, respectively. Eighty-two centers (92%) have never performed HT in HIV(+) patients and 51 centers (57%) marked HIV(+) status as a contraindication. Rationales for contraindication included: (1) high-risk patients should be avoided given the scarcity of organ supply (59%); (2) immunosuppression required for HT may induce progression to AIDS (51%); and (3) drug interactions may worsen patients' clinical outcomes (49%). Thirty-five left ventricular assist device (LVAD) implantations in HIV(+) patients were reported. Sixty-eight centers (76%) have never implanted an LVAD in an HIV(+) patient and 21 centers (20%) marked HIV(+) status as a contraindication, of which 61% indicated concern for device-related infection.
  
  
  CONCLUSIONS
  Most centers either explicitly consider HIV(+) status as a contraindication for or have never treated HIV(+) patients with advanced HF therapy. Our findings suggest unequal access to care and underscore the need to educate cardiovascular health-care providers on progress made with HIV therapies.
authors.affiliation: Division of Cardiology, University of Chicago, Chicago, Illinois. Electronic address: nuriel@medicine.bsd.uchicago.edu.
authors.forename: Nir
authors.initials: N
authors.lastname: Uriel
authors.affiliation: Division of Cardiology, New York Presbyterian Hospital and Columbia University Medical Center, New York, New York.
authors.forename: Nadav
authors.initials: N
authors.lastname: Nahumi
authors.affiliation: Division of Cardiology, New York Presbyterian Hospital and Columbia University Medical Center, New York, New York.
authors.forename: Paolo C
authors.initials: PC
authors.lastname: Colombo
authors.affiliation: Division of Cardiology, New York Presbyterian Hospital and Columbia University Medical Center, New York, New York.
authors.forename: Melana
authors.initials: M
authors.lastname: Yuzefpolskaya
authors.affiliation: Division of Cardiology, New York Presbyterian Hospital and Columbia University Medical Center, New York, New York.
authors.forename: Susan W
authors.initials: SW
authors.lastname: Restaino
authors.affiliation: Division of Cardiology, New York Presbyterian Hospital and Columbia University Medical Center, New York, New York.
authors.forename: Jason
authors.initials: J
authors.lastname: Han
authors.affiliation: Division of Cardiology, New York Presbyterian Hospital and Columbia University Medical Center, New York, New York.
authors.forename: Sunu S
authors.initials: SS
authors.lastname: Thomas
authors.affiliation: Division of Cardiology, New York Presbyterian Hospital and Columbia University Medical Center, New York, New York.
authors.forename: Arthur R
authors.initials: AR
authors.lastname: Garan
authors.affiliation: (c)Division of Cardiothoracic Surgery, New York Presbyterian Hospital and Columbia University Medical Center, New York, New York.
authors.forename: Hiroo
authors.initials: H
authors.lastname: Takayama
authors.affiliation: Division of Cardiology, New York Presbyterian Hospital and Columbia University Medical Center, New York, New York.
authors.forename: Donna M
authors.initials: DM
authors.lastname: Mancini
authors.affiliation: (c)Division of Cardiothoracic Surgery, New York Presbyterian Hospital and Columbia University Medical Center, New York, New York.
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Naka
authors.affiliation: Division of Cardiology, New York Presbyterian Hospital and Columbia University Medical Center, New York, New York.
authors.forename: Ulrich P
authors.initials: UP
authors.lastname: Jorde
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002170:Canada; D015897:Comorbidity; D000075202:Contraindications; D003625:Data Collection; D018450:Disease Progression; D015658:HIV Infections / Q000150:complications* / Q000401:mortality; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006333:Heart Failure / Q000209:etiology* / Q000401:mortality / Q000628:therapy*; D016027:Heart Transplantation / Q000706:statistics & numerical data; D006353:Heart-Assist Devices / Q000706:statistics & numerical data; D006801:Humans; D008875:Middle Aged; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult
keywords: contraindication; heart transplantation; human immunodeficiency virus; survey; ventricular assist device