Patients With HIV at Increased Risk of Pneumonia, Readmission After Cardiac Surgery

Pneumonia and readmission were higher in patients who were living with HIV who needed cardiac surgery, according to a study published by JTCVS Open.¹ Patients with HIV also had lower rates of cardiac surgery, which could imply limited access to the surgeries.

Cardiovascular disease has a higher risk of occurring in people who are living with HIV compared with those without the disease, according to a study published in the Journal of the American Heart Association.² The study found that patients with HIV are at a greater risk of myocardial infarction, heart failure, and stroke, among other cardiovascular diseases. However, the risk of cardiac surgery for those with HIV has not been as thoroughly studied, including those whose viral load has been suppressed using antiretroviral therapy (ART). This study aimed to assess the primary risks of cardiac surgery for patients living with HIV who needed the operation.

Hands holding red ribbon for HIV awareness | Image credit: SewcreamStudio - stock.adobe.com

The retrospective cohort study used the PearlDiver Database to collect data on patients with HIV living in the US. The database included data for 91 million patients spanning from 2010 to 2020. The researchers identified patients who had risk factors for heart disease. These patients were separated into 2 groups based on reports of hospitalizations due to HIV. Patients were also classified into the type of cardiac surgery that they had if a surgery was performed. Patients were included in study outcomes if they had active records and were enrolled with their insurance carrier at the follow-up.

Outcome variables that were assessed in this study included the length of stay (LOS), stroke, myocardial infarction, heart failure, pneumonia, renal injury, and 30-day all-cause readmission. Outcomes were assessed using 30-day follow-up records. Only the first admission for an ailment was included in this study.

There were 59,695 patients living with HIV who were a part of the PearlDiver Database out of 14,714,743 patients who had data on hospital admissions. Patients with HIV were younger, more often male, more often smokers, were obese, were sicker, and had greater rates of hypertension and chronic obstructive pulmonary disease (COPD), among other ailments. These differences were most pronounced in the rates of tobacco use (40.17% vs 17.06%), polysubstance abuse (35.17% vs 7.06%), cerebrovascular disease (18.25% vs 2.71%), and chronic liver disease (28.82% vs 7.25%) in people living with HIV vs those not living with HIV.

Patients who were living with HIV and were undergoing cardiac surgery were more often younger, had more comorbidities, had a history of smoking or substance use, were more often male, and were less often insured; greater rates of hypertension, COPD, chronic lung disease, chronic kidney disease, and heart failure were also found in this cohort.

Pneumonia (2.67% vs 1.54%; relative risk, 1.7) and 30-day readmission (15.69% vs 12.05%; relative risk, 1.28) had higher rates of occurrence after cardiac surgery in patients who were living with HIV compared with those who were not. LOS, stroke, heart failure, myocardial infarction, and renal injury were not significantly different between the 2 groups. Patients who were using highly active ART were found to have lower rates of readmission compared with other patients living with HIV (14.58% vs 18.10%) but no other differences were found.

There were some limitations to this study. Only a small percentage of the patients living with HIV who were included in the database had undergone cardiac surgery, which limited the results. Selection bias was possible due to only including inpatient data where patients with HIV were sicker.

The researchers concluded that patients living with HIV were at increased risk of pneumonia and 30-day readmission when having cardiac surgery. Future studies should focus on a larger clinical datasets to confirm these results are upheld in different cohorts.

References

1. Zadeh AV, Justicz A, Plate J, Cortelli M, Wang I, Melvan JN. Human immunodeficiency virus infection is associated with greater risk of pneumonia and readmission after cardiac surgery. JTCVS Open. 2024;18:145-155. doi:10.1016/j.xjon.2024.01.002
2. Alonso A, Barnes AE, Guest JL, Shao IY, Marconi V. HIV infection and incidence of cardiovascular diseases: an analysis of a large healthcare database. J Am Heart Assoc. 2019;8:e01224. doi:10.1161/JAHA.119012241