Advanced heart failure in patients infected with human immunodeficiency virus: Is there equal access to care?

Nir Uriel, Nadav Nahumi, Paolo C. Colombo, Melana Yuzefpolskaya, Susan W. Restaino, Jason Han, Sunu S. Thomas, Arthur R. Garan, Hiroo Takayama, Donna M. Mancini, Yoshifumi Naka, Ulrich P. Jorde

Research output: Contribution to journalArticle

23 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)924-930
Number of pages7
JournalJournal of Heart and Lung Transplantation
Volume33
Issue number9
DOIs
StatePublished - Sep 2014
Externally publishedYes

Keywords

  • contraindication
  • heart transplantation
  • human immunodeficiency virus
  • survey
  • ventricular assist device

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine
  • Transplantation

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    Uriel, N., Nahumi, N., Colombo, P. C., Yuzefpolskaya, M., Restaino, S. W., Han, J., Thomas, S. S., Garan, A. R., Takayama, H., Mancini, D. M., Naka, Y., & Jorde, U. P. (2014). Advanced heart failure in patients infected with human immunodeficiency virus: Is there equal access to care? Journal of Heart and Lung Transplantation, 33(9), 924-930. https://doi.org/10.1016/j.healun.2014.04.015