TY - JOUR
T1 - Advanced heart failure in patients infected with human immunodeficiency virus
T2 - Is there equal access to care?
AU - Uriel, Nir
AU - Nahumi, Nadav
AU - Colombo, Paolo C.
AU - Yuzefpolskaya, Melana
AU - Restaino, Susan W.
AU - Han, Jason
AU - Thomas, Sunu S.
AU - Garan, Arthur R.
AU - Takayama, Hiroo
AU - Mancini, Donna M.
AU - Naka, Yoshifumi
AU - Jorde, Ulrich P.
PY - 2014/9
Y1 - 2014/9
N2 - 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.
AB - 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.
KW - contraindication
KW - heart transplantation
KW - human immunodeficiency virus
KW - survey
KW - ventricular assist device
UR - http://www.scopus.com/inward/record.url?scp=84906077527&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84906077527&partnerID=8YFLogxK
U2 - 10.1016/j.healun.2014.04.015
DO - 10.1016/j.healun.2014.04.015
M3 - Article
C2 - 24929646
AN - SCOPUS:84906077527
SN - 1053-2498
VL - 33
SP - 924
EP - 930
JO - Journal of Heart and Lung Transplantation
JF - Journal of Heart and Lung Transplantation
IS - 9
ER -