Having HIV, particularly ongoing HIV reproduction, is an independent risk factor for developing heart failure, according to a study published in the April 25 issue of the Archives of Internal Medicine.

Numerous studies have found that HIV has a negative influence on heart health. Some studies have found an increased risk of heart attacks, while others have documented blood vessel dysfunction. Not all studies have consistently confirmed that HIV causes heart troubles, however, and since many people with HIV have other known risk factors—such as smoking, diabetes and histories of drug abuse—experts are still trying to pinpoint the role HIV plays in cardiovascular dysfunction.

One type of heart problem that hasn’t been studied well is heart failure. Heart failure is when the body can’t pump enough blood to meet its needs. Left untreated, heart failure can cause shortness of breath and fluid retention and potentially lead to liver damage, kidney failure, heart valve problems and either a heart attack or stroke.

To better understand how HIV influences the risk of heart failure, Adeel Butt, MD, from the University of Pittsburgh School of Medicine, and his colleagues studied the medical records of people enrolled in two large military cohorts: the Veterans Aging Cohort Study Virtual Cohort (VACS-VC) and the 1999 Large Health Study of Veteran Enrollees (LHS).

Nearly 8,500 people were included in the analysis, 2,391 of whom were HIV positive and 6,095 of whom were HIV negative. Most people were followed for about seven years, and the average age was 48. Roughly 40 percent were African American, and 10 percent were Latino. People with HIV were about three times as likely to have hepatitis C virus (HCV), whereas HIV-negative participants were more likely to have diabetes and hypertension. Rates of drug use and nicotine use were equally high in both groups.

Butt and his colleagues found that the risk for heart failure was 81 percent higher in the HIV-positive participants after adjusting for traditional risk factors. Other factors that also conferred a higher risk for heart failure included increasing age, African-American race, current smoking, obesity, hypertension, diabetes and a diagnosis of alcohol abuse or dependence.

Of note, HIV itself remained a risk factor even when Butt’s team looked only at people who never had a diagnosis of chronic heart disease or alcohol abuse—two causes of heart failure. Among the HIV-positive participants, having 500 or more copies of HIV at the time the study started also made it significantly more likely that a person would develop heart failure, which lends more weight to the possibility that HIV all by itself might be damaging the heart in some way.

According to the authors, these data, along with others showing higher risks for heart problems in those with uncontrolled HIV levels, point to the need to keep HIV reproduction in check.

“Ongoing viral replication is associated with a higher risk of [heart failure],” they conclude. “Further studies to fully characterize this association and to understand the underlying mechanisms are warranted.”