Depression and HIV Are Risk Factors for Incident Heart Failure Among Veterans

Background: HIV infection is associated with an increased risk of heart failure (HF). Depression, a common comorbidity among HIV infected (HIV+) and uninfected (HIV-) people, is also associated with HF. The high prevalence of clinical depression among HIV+ adults is concerning due to increased risk of HF among HIV+ people. This study examined the association between depression and HF in a large cohort of HIV+ and HIV- Veterans. Methodology: We analyzed data on 81,427 Veterans (33% HIV+) without prevalent cardiovascular disease (CVD) from the Veterans Aging Cohort Study – Virtual Cohort (VACS VC), a prospective study of HIV+ and their age-, sex-, race/ethnicity- and clinical site-matched HIV- Veterans. Veterans were followed from their first clinical encounter on or after 4/1/2003 until a HF event, death, or their last follow-up date (12/31/2009). Using baseline diagnoses of Major Depressive Disorder (MDD; ICD-9 codes 296.2x & 296.3x), participants were categorized into 4 groups: HIV- without depression (referent), HIV- with depression; HIV+ without depression; and HIV+ with depression. HF was determined using VA and Medicare ICD-9 codes (428.xx, 429.3, 402.01, 402.11, 402.91, 425.xx). Cox proportional hazards regression was used to model the association between depression, HIV-infection, and incident HF, adjusting for demographics, serum lipids, smoking, blood pressure, diabetes, renal disease, obesity, hepatitis C, atrial fibrillation, and atrial flutter, and substance use. Secondary analysis restricted the assessment to include only HIV+ patients, adjusting the same covariates plus HIV-specific risk factors. Results: During a median of 5.9 years of follow-up, there were 2666 HF events (38% HIV+). HF rates per 1000 person-years and risks adjusting for covariates are presented in Table 1 by HIV status and MDD diagnosis. Compared to Veterans without either condition, those with only MDD, with only HIV, or with both HIV and MDD were at higher risk for incident HF (Table 1). Among HIV+ Veterans, MDD remained a significant risk factor for HF after adjusting for covariates in Table 1 and baseline ART regimen, CD4 count, and viral load (HR(95%): 1.30 (1.11 – 1.51)) and with recent (i.e., within 6 months of event) ART regimen, recent CD4 count, and recent viral load (HR(95%): 1.27 (1.09 – 1.48)). Conclusions: Depression is associated with an increased risk for incident HF regardless of HIV status. Among those with HIV, depressed Veterans had higher rates of HF compared to those without depression.