by Jeffrey T. Kirchner, DO, AAHIVS, AAHIVM Chief Medical Officer

December 1, 2020

Featured Literature:

Wollner G, et al. Outcomes of coronary artery bypass grafting in patients with human immunodeficiency virus infection. J Card Surg. 2020 Oct;35(10):2543-2549

It has been known for many years that persons with HIV (PWH) are at increased risk for cardiovascular disease and associated complications including myocardial infarction and heart failure. Moreover, the aging of PWH has resulted in a higher prevalence of CVD. Although the emphasis should be on primary prevention of CVD, many patients will need interventions including angioplasty or cardiac bypass surgery. This small study from the Medical University of Vienna looked at outcomes of 16 PWH who underwent CABG at their institution. The patients’ average age was 56 ± 9.8 years and 100% were male. They were all taking ART with viral load < 50 copies/mL and median CD4+ count of 580 cells/mm3. There was a high incidence of CVD risk factors noted including hypertension (87%), smoking (50%) and diabetes (38%). There was also a high incidence of prior MI (56.3%). The primary endpoint of the study was survival and secondary endpoints included the components of major adverse cardiac and cerebrovascular events (MACCE): cardiovascular death, stroke, myocardial infarction (MI), and repeat revascularization. The patients were followed for a median of 49 months with a range of 7 to 142 months. The survival post-CABG at one year was 100% and at 3 years was 90%. Two patients sustained an MI and required repeated revascularization. There were no strokes reported during the course of follow up. The authors conclude that for PWH with complex coronary disease, CABG affords good short and mid-term survival as well as prevention of major adverse cardiac events.

Author’s Commentary:

This is a small but reassuring study regarding good outcomes in PWH who require CABG for treatment of coronary artery disease. Preventive measures including smoking cessation, management of lipids, blood pressure and glycemic control remain very important as well. This study was of some personal interest as my last patient with HIV who underwent CABG did not survive his procedure – although he had several other comorbidities including advanced systolic heart failure and COPD. With the aging of PWH, a greater number will undoubtedly require cardiac procedures and provided their HIV is well-controlled, we should expect favorable outcomes.

The author has no conflicts of interest to disclose.

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