Skip to main content

Advertisement

SpringerLink
Log in

Incidence and risk factors of atrial fibrillation and atrial arrhythmias in people living with HIV: a systematic review and meta-analysis

  • Published:
Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Background

Cardiovascular diseases in people living with HIV (PLWH) are becoming increasingly relevant as HIV/AIDS has become more treatable with the advent of highly efficacious antiretroviral therapy. Previous studies suggested that HIV infection is an independent risk factor for atrial arrhythmia. This study aims to collectively analyze these studies to elucidate the incidence and risk factors of atrial arrhythmia in PLWH.

Methods

Full-text assessments and data extraction were performed from available literature. Atrial arrhythmia was defined as atrial fibrillation or atrial flutter. Incidence rate, risk, and potential risk factors of atrial arrhythmia in PLWH were catalogued, after which random-effects models were used to estimate pooled summary statistics. PRISMA standardized meta-analysis guidelines were followed.

Results

Analysis of 94,928 PLWH had an averaged incidence rate of 6.4 cases of atrial arrhythmia per 1000 person-years. Risk of atrial arrhythmia was significantly higher in PLWH than in the general population (RR 1.35; 95% CI 1.19–1.53). Sex had no association with the risk of incidental atrial arrhythmia in PLWH (RR 1.47; 95% CI 0.95–2.28). Black race (RR 0.68; 95% CI 0.47–0.97) was associated with decreased risk, whereas lower CD4 counts (RR 1.80; 95% CI 1.18–2.77) and increased viral load (RR 1.57; 95% CI 1.19–2.09) suggested increased risk of atrial arrhythmia in PLWH.

Conclusions

HIV infection is a risk factor of atrial arrhythmia. Providers should be aware of the increased burden of atrial arrhythmia in PLWH and continue to encourage treatment of HIV infection while managing cardiovascular risk factors and screening for arrhythmias in symptomatic patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. UNAIDS Report on the Global AIDS Epidemic. 2020 [cited 2021 September 1]; Available from: https://www.unaids.org/.

  2. Survival of HIV-positive patients starting antiretroviral therapy between 1996 and 2013: a collaborative analysis of cohort studies. Lancet HIV 2017 4(8):e349-e356.

  3. Rodger AJ, et al. Mortality in well controlled HIV in the continuous antiretroviral therapy arms of the SMART and ESPRIT trials compared with the general population. AIDS. 2013;27(6):973–9.

    Article  CAS  Google Scholar 

  4. Cohen MS, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011;365(6):493–505.

    Article  CAS  Google Scholar 

  5. Global, regional, and national age-sex specific mortality for 264 causes of death, 1980–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet, 2017. 390(10100): 151–1210.

  6. Feinstein MJ, et al. Patterns of cardiovascular mortality for HIV-infected adults in the United States: 1999 to 2013. Am J Cardiol. 2016;117(2):214–20.

    Article  Google Scholar 

  7. Grunfeld C, et al. Preclinical atherosclerosis due to HIV infection: carotid intima-medial thickness measurements from the FRAM study. AIDS. 2009;23(14):1841–9.

    Article  Google Scholar 

  8. Lorgis L, et al. Outcomes after acute myocardial infarction in HIV-infected patients: analysis of data from a French nationwide hospital medical information database. Circulation. 2013;127(17):1767–74.

    Article  Google Scholar 

  9. Chow FC, et al. Comparison of ischemic stroke incidence in HIV-infected and non-HIV-infected patients in a US health care system. J Acquir Immune Defic Syndr. 2012;60(4):351–8.

    Article  Google Scholar 

  10. Dominick L, et al. HIV-related cardiovascular diseases: the search for a unifying hypothesis. Am J Physiol Heart Circ Physiol. 2020;318(4):H731–46.

    Article  CAS  Google Scholar 

  11. Moher D, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev. 2015;4(1):1.

    Article  Google Scholar 

  12. Alonso A, et al. Incidence of atrial fibrillation in whites and African-Americans: the Atherosclerosis Risk in Communities (ARIC) study. Am Heart J. 2009;158(1):111–7.

    Article  Google Scholar 

  13. Elnahar Y, et al. Risk factors for the development of atrial fibrillation in HIV Infected Patients. J Atr Fibrillation. 2012;4(6):404.

    PubMed  PubMed Central  Google Scholar 

  14. Hsu JC, et al. Atrial fibrillation and atrial flutter in human immunodeficiency virus-infected persons: incidence, risk factors, and association with markers of HIV disease severity. J Am Coll Cardiol. 2013;61(22):2288–95.

    Article  Google Scholar 

  15. Lai YJ, et al. Incidence of cardiovascular diseases in a nationwide HIV/AIDS patient cohort in Taiwan from 2000 to 2014. Epidemiol Infect. 2018;146(16):2066–71.

    Article  Google Scholar 

  16. Sanders JM, et al. Atrial arrhythmia prevalence and characteristics for human immunodeficiency virus-infected persons and matched uninfected controls. PLoS ONE. 2018;13(3): e0194754.

    Article  Google Scholar 

  17. Sardana M, et al. Human immunodeficiency virus infection and incident atrial fibrillation. J Am Coll Cardiol. 2019;74(11):1512–4.

    Article  Google Scholar 

  18. Osuji N, et al. Association between human immunodeficiency virus serostatus and the prevalence of atrial fibrillation. Medicine (Baltimore). 2021;100(29): e26663.

    Article  CAS  Google Scholar 

  19. Johansson C, et al. Incidence, type of atrial fibrillation and risk factors for stroke: a population-based cohort study. Clin Epidemiol. 2017;9:53–62.

    Article  Google Scholar 

  20. Vermond RA, et al. Incidence of atrial fibrillation and relationship with cardiovascular events, heart failure, and mortality: a community-based study from the Netherlands. J Am Coll Cardiol. 2015;66(9):1000–7.

    Article  Google Scholar 

  21. Pothineni NV, Vallurupalli S. Gender and atrial fibrillation: differences and disparities. US Cardiol Rev. 2018;12(2):103–6.

    Article  Google Scholar 

  22. Stamos TD, Darbar D. The “double” paradox of atrial fibrillation in Black individuals. JAMA Cardiol. 2016;1(4):377–9.

    Article  Google Scholar 

  23. Kowlgi GN, et al. Comparison of frequency of atrial fibrillation in Blacks versus Whites and the utilization of race in a novel risk score. Am J Cardiol. 2020;135:68–76.

    Article  Google Scholar 

  24. Lederman MM, et al. Residual immune dysregulation syndrome in treated HIV infection. Adv Immunol. 2013;119:51–83.

    Article  CAS  Google Scholar 

  25. Zicari, S., et al. 2019, Immune activation, inflammation, and non-AIDS co-morbidities in HIV-infected patients under long-term ART. Viruses 11(3).

  26. Gupta MK, et al. HIV-1 Nef-induced cardiotoxicity through dysregulation of autophagy. Sci Rep. 2017;7(1):8572.

    Article  Google Scholar 

  27. Korantzopoulos P, et al. Inflammation and atrial fibrillation: a comprehensive review. J Arrhythm. 2018;34(4):394–401.

    Article  Google Scholar 

  28. Galea R, et al. Inflammation and C-reactive protein in atrial fibrillation: cause or effect? Tex Heart Inst J. 2014;41(5):461–8.

    Article  Google Scholar 

  29. Titanji B, et al. Targeting inflammation to reduce atherosclerotic cardiovascular risk in people with HIV infection. J Am Heart Assoc. 2020;9(3): e014873.

    Article  Google Scholar 

  30. Deeks SG, Tracy R, Douek DC. Systemic effects of inflammation on health during chronic HIV infection. Immunity. 2013;39(4):633–45.

    Article  CAS  Google Scholar 

  31. Chung MK, et al. C-reactive protein elevation in patients with atrial arrhythmias: inflammatory mechanisms and persistence of atrial fibrillation. Circulation. 2001;104(24):2886–91.

    Article  CAS  Google Scholar 

  32. Yatsuya H, et al. Global trend in overweight and obesity and its association with cardiovascular disease incidence. Circ J. 2014;78(12):2807–18.

    Article  Google Scholar 

  33. Kornej J, et al. Epidemiology of atrial fibrillation in the 21st century: novel methods and new insights. Circ Res. 2020;127(1):4–20.

    Article  CAS  Google Scholar 

Download references

Author information

Author notes

  1. Dae Yong Park and Seokyung An contributed equally to this paper.

Authors and Affiliations

  1. Department of Medicine, John H. Stroger Jr Hospital of Cook County, 1901 W. Harrison Street, Suite 3620, Chicago, IL, 60612, USA

    Dae Yong Park & Maria Emilia Romero

  2. Department of Biomedical Science, Seoul National University Graduate School, Seoul, South Korea

    Seokyung An

  3. Department of Pathology, McGaw Medical Center of Northwestern University, Chicago, IL, USA

    Amandeep Kaur

  4. Warren Clinic Cardiology, Saint Francis Health System, Tulsa, OK, USA

    Venkatesh Ravi

  5. Division of Cardiology, Rush University Medical Center, Chicago, IL, USA

    Henry D. Huang

  6. Division of Cardiology, Cook County Health, Chicago, IL, USA

    Aviral Vij

  7. Division of Cardiology, Rush Medical College, Chicago, IL, USA

    Aviral Vij

Authors
  1. Dae Yong Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Seokyung An
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Maria Emilia Romero
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Amandeep Kaur
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Venkatesh Ravi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Henry D. Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Aviral Vij
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Aviral Vij.

Ethics declarations

Ethics approval

This study was exempt from ethics approval as only data from previously published studies were retrieved and synthesized.

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Park, D.Y., An, S., Romero, M.E. et al. Incidence and risk factors of atrial fibrillation and atrial arrhythmias in people living with HIV: a systematic review and meta-analysis. J Interv Card Electrophysiol 65, 183–191 (2022). https://doi.org/10.1007/s10840-022-01233-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10840-022-01233-w

Keywords

Search

Navigation