People living with HIV (PWH) are at an increased risk of cardiovascular disease and electrophysiological changes that may lead to sudden cardiac death (SCD). SCD was twice as common in PWH in a recent research published in New England Journal of Medicine; however, one in three fatalities was attributed to overdose.

Researchers have now utilised the Veterans Aging Cohort Study (VACS) data to investigate the link between HIV and SCD. PWH made for 30% of the over 144,000 VACS participants (median age 50) (median baseline CD4 count 385 cells/L).

Hypertension, diabetes, raised LDL cholesterol, obesity, alcohol use, COPD, and cardiovascular disease were more common among HIV-negative veterans. 3035 SCDs occurred throughout a median 9-year follow-up; incidence rose with age in HIV-positive and HIV-negative veterans.

With a lower baseline CD4 cell count and a higher HIV viral load, the risk of SCD increased in PWH. When confounders were taken into account, PWH had a 14% greater risk of SCD than HIV-negative people. PWH with a baseline CD4 count of 200 cells/L had a 29 % greater risk, while PWH with a baseline HIV-1 viral load of >500 copies/ml had a 17 % higher risk. HIV infection was linked to a % higher incidence of SCD in a study confined to never-smokers.

The analysis revealed that advanced HIV infection is linked to an increased risk of SCD and that cardiovascular risk factor modification should be essential for primary HIV care.