Multidrug-Class Antiretroviral Regimens Associated With Incident Atrial Fibrillation

Coronary artery disease (CAD), heart failure, chronic obstructive pulmonary disease (COPD), older age, Hispanic ethnicity, lack of prior treatment with antiretroviral therapy (ART), and the use of multidrug-class ART were associated with incident atrial fibrillation (AF) among patients with HIV infection, according to study results published in AIDS.

Researchers conducted a case-control analysis using data from the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) to determine risk factors for incident AF among patients with HIV infection. Incidence density sampling was performed to match each patient with HIV infection and AF against 10 control patients without AF. The researchers also obtained information regarding patients’ medication regimens and, comorbidities, and history of illicit substance via self-administered questionnaires. Multidrug-class ART was defined as ART regimens comprising 1 or more drugs from the following core classes: protease inhibitors, non-nucleoside reverse transcriptase inhibitors, and integrase strand transfer inhibitors.

Among 148 potential cases of patients with AF, incident AF was confirmed in 97 (positive predictive value, 66%). Of these patients, the median age was 56 years, 90% were men, and rhythm at the time of diagnosis was AF, atrial flutter, or both, in 73%, 14%, and 7%, respectively. Of note, 5% of patients with AF were diagnosed via implanted devices or ambulatory monitors. Exacerbation of underlying CAD, heart failure, and COPD was identified in 4%, 11%, and 8% of patients, respectively.

Compared with 970 patients in the control group, the median nadir CD4 count was increased in patients with incident AF (195 vs 159 cells/mm³). Although the use of single-class ART was decreased among patients with AF vs those in the control group (12% vs 16%), the use of multidrug-class ART was increased (33% vs 14%). Similar results were observed in regard to the number of patients in both groups who reported a history of alcohol use, cigarette smoking, or use of illicit substances. After performing multivariate conditional logistic regression, the researchers found that older age, CAD, heart failure, COPD, lack of prior ART treatment, multidrug-class ART treatment, and Hispanic ethnicity were associated with incident AF.

This study was limited by the small number of patients with incident AF, and there was potential residual confounding.

The researchers concluded that “research is needed to clarify the roles of specific [ART] regimens and inflammation in AF development.”

Disclosure: Some authors declared affiliations with pharmaceutical, biotech, and/or device companies. Please see the original reference for a full list of disclosures.

Reference

Nance RM, Delaney JAC, Floyd JS, et al. Risk factors for atrial fibrillation in a multi-center US clinical cohort of people with HIV infection. AIDS. Published online February 25, 2022. doi:10.1097/QAD.0000000000003180