Clinical outcomes of ventricular assist device support by HIV infection status: An STS-INTERMACS analysis

J Heart Lung Transplant. 2023 Sep;42(9):1185-1193. doi: 10.1016/j.healun.2023.04.014. Epub 2023 May 3.

Abstract

Background: Cardiovascular disease remains the leading cause of mortality in human immunodeficiency virus-infected (HIV-positive) patients. Ventricular assist device therapy is rarely offered to these patients and data on outcomes are sparse. We investigated outcomes following ventricular assist device implants for HIV-positive as compared to non-HIV-infected (HIV-negative) patients.

Methods: We analyzed 22,065 patients from the Interagency Registry for Mechanically Assisted Circulatory Support registry for outcomes by HIV status. A propensity-matched analysis adjusting for 21 preimplant risk factors was also conducted.

Results: Compared with 21,980 HIV-negative device recipients, the 85 HIV-positive recipients were younger (median age 58 years vs 59 years, p = 0.02), had lower body mass index (26 kg/m2 vs 29 kg/m2, p = 0.001), and had higher rates of prior stroke (8% vs 4%, p = 0.02). In the matched HIV-positive and HIV-negative cohorts, there was significantly higher mortality in HIV-positive patients in earlier implant years, however, this association was not seen in later implant years (2018-2020). In both unmatched and matched cohorts, no significant differences in postimplantation stroke, major bleeding, or major infection were noted.

Conclusions: With recent advancements in mechanical circulatory support and HIV treatment, ventricular assist device therapy is a viable therapeutic option for HIV-positive patients with end-stage heart failure.

Keywords: HIV; heart failure; mechanical circulatory support; ventricular assist device.

MeSH terms

  • HIV Infections* / complications
  • Heart Failure* / complications
  • Heart Failure* / therapy
  • Heart-Assist Devices*
  • Humans
  • Middle Aged
  • Registries
  • Retrospective Studies
  • Risk Factors
  • Treatment Outcome