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21 May 2012
Researchers explore HIV heart attack link
by George Atkinson

A 10-year University of California, San Francisco (UCSF), study has found patients with HIV/AIDS suffered sudden cardiac death at a rate four times higher than the general population.

"I noticed that many of these cases involved individuals with HIV infection who were dying suddenly," explained study author Zian H. Tseng, an electrophysiologist and an associate professor of medicine in the UCSF Division of Cardiology. "I wondered if there was some sort of connection there."

Working with Priscilla Hsue, director of the HIV Cardiology Clinic at San Francisco General Hospital, the pair conducted a retrospective study of 2,860 HIV patients to comprehensively characterize all deaths. They studied medical records, death certificates, paramedic reports, and interviews with family members, doctors, and other clinicians.

The researchers used well-established criteria for retrospectively identifying death as either HIV-related or sudden death-related. If there was any doubt, they classified sudden death as an HIV death. "In other words, for someone with a CD4 [T-cell] count less than 50 who died suddenly, we classified that as an HIV death, rather than a sudden death because of the profound immunodeficiency," Tseng explained.

"We're able to compare the rate of sudden death in this population with the overall San Francisco population," Tseng added. "So adjusted for age, race, demographics, and other variables, the rate of sudden death in the HIV population is more than four times higher than the general population."

The study notes that HIV changes the electrophysiology of the heart in a way so pronounced that it causes conduction abnormalities. And many HIV medications can throw off the heart's electrical cycle by prolonging the QT interval, which increases the risk of sudden death. These and other variables could be contributing factors.

"Now that HIV-infected individuals are living longer with the benefit of antiretroviral therapy, non-AIDS conditions are becoming increasingly important and at the top of this list is cardiovascular disease," Hsue concluded.

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Source: University of California - San Francisco

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