Major adverse cardiovascular events, morbidity, and mortality, among people living with and without HIV in two northern Uganda hospitals

Abstract

Cardiovascular disease (CVD) morbidity and mortality are increasing globally, including among patients living with human immunodeficiency virus (HIV). We aimed to determine the risk of all-cause mortality and morbidity in patients with CVD, comparing those with and without HIV infection, and whether mortality differed by HIV status during hospitalization for Major Adverse Cardiovascular Events (MACE) components (stroke, acute myocardial infarction (AMI), and heart failure) in northern Uganda. We conducted a retrospective cohort study at two hospitals in northern Uganda, comparing outcomes in CVD patients with and without HIV hospitalized from January 2015 to June 2023. We utilized a logistic regression model for crude, adjusted, and stratified analyses of MACE components and mortality by HIV status. Among 2,127 CVD patient records analyzed, 292 (13.7%) had HIV. During hospitalization, 26.0% of patients living with HIV (PLWH) died compared with 15.8% of those without HIV. Similarly, among patients who experienced MACE, mortality was higher in PLWH than in those without HIV, including heart failure (38.1% vs. 22.9%), AMI (60.0% vs. 36.5%), and strokes (41.8% vs. 27.8%). In multivariable analyses, patients with cardiovascular disease living with HIV had higher odds of all-cause mortality compared with patients without HIV (aOR: 2.30, 95% CI: [1.32, 3.98], p = 0.003). Among individual MACE components, the odds of mortality were higher among those living with HIV, including heart failure (aOR: 3.06, CI: [1.56, 6.32], p = 0.001), AMI (aOR: 9.07, CI: [4.55, 18.77], p < 0.001), and stroke, (aOR: 2.5, CI: [1.15, 5.42], p = 0.02). We assessed whether HIV modifies the relationship between MACE and odds of mortality, interaction terms (example, HIV*Stroke) showed no statistical evidence of effect modification, with HIV-interaction term p-values: heart failure (p = 0.465), stroke (p = 0.613), and AMI (p = 0.615). All-cause mortality risk was higher among CVD patients living with HIV compared to those without. Although patients living with HIV who experienced MACE had higher in-hospital mortality, there was no statistical evidence of effect modification by HIV status. Further research is needed to understand the underlying pathophysiological mechanisms and mortality risks among patients hospitalized with MACE, including both medium- and long-term post hospitalization.