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Outcomes of mechanical circulatory support in HIV infected patients from the INTERMACS registry

Outcomes of mechanical circulatory support in HIV infected patients from the INTERMACS registry. Salpy V. Pamboukian MD MSPH Intermacs Annual Meeting May 15-16 th , 2015. Background and Purpose.

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Outcomes of mechanical circulatory support in HIV infected patients from the INTERMACS registry

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  1. Outcomes of mechanical circulatory support in HIV infected patients from the INTERMACS registry Salpy V. Pamboukian MD MSPH IntermacsAnnual Meeting May 15-16th, 2015 HIV Study-Pamboukian

  2. Background and Purpose • There is limited published data on the outcomes of HIV infected patients requiring mechanical circulatory support (MCS) • Prevalence of 1.2 million cases in the U.S. (CDC, 2011) • With cART therapy, HIV has been converted into a “chronic disease” • High prevalence of cardiac risk factors  smoking 60-70% • 6.5% of HIV-related mortality is related to CV disease (1) • Prevalence of LV dysfunction was 18% in one large echo series (2) • The purpose of our study was to analyze outcomes in HIV infected patients with MCS enrolled in the INTERMACS registry • 1. Causes of death in HIV-1-infected patients treated with antiretroviral therapy, 1996–2006: collaborative analysis of 13 HIV cohort studies • Clin Infect Dis, 50 (2010), pp. 1387–1396 2. Mondy KE et al. Clin Infect Dis 2011;52:378–86. HIV Study-Pamboukian

  3. Methods • INTERMACS enrolled 14,039 primary prospective patients between June 23, 2006 and March 31, 2015, of these 28 were identified with a pre-implant HIV positive status. Three patients with pulsatile flow devices were excluded from further analysis. • Baseline characteristics (age, race, gender, device strategy, patient profile, time since cardiac diagnosis, and etiology) were compared for patients receivingcontinuous flow LVADs with HIV (n=25) and without HIV (n=12,351). P-values were calculated using Fisher’s exact test or the Wilcoxon rank sum test. • The difference in survival on a device for patients receiving continuous flow LVADs with HIV (n=25) and without HIV (12,351) was analyzed using Kaplan-Meier survival curves using time to death as the event and censoring at transplant or ventricular recovery (device removed or turned off). The p-value was calculated using the log-rank test. • Competing outcome methodology was used to estimate the time related percentage of patients receiving continuous flow LVADs with HIV that would be alive on a device, deceased, transplant, and recovered. • Adverse event rates and infection rates by location were calculated by totaling the number of specific events observed in an early period (3 months post implant or earlier) and late period (after 3 months post implant). HIV Study-Pamboukian

  4. Distribution of Pre-implant HIV Status for Primary Prospective Patients by Device Type, Flow Type Cohort Selection INTERMACS Primary Prospective Implants June 23, 2006 – March 31, 2015 N = 14,039 LVAD N = 12,992 BiVAD N = 736 TAH N = 311 Continuous Flow N = 12,376 Pulsatile Flow N = 616 Pre-Implant HIV Yes = 2 No = 614 Pre-Implant HIV Yes = 25 No = 12,351 Pre-Implant HIV Yes = 1 No = 735 Pre-Implant HIV Yes = 0 No = 311 HIV Study-Pamboukian

  5. Patients Characteristics by HIV Status HIV Study-Pamboukian

  6. Patients Characteristics by HIV Status (Continued) HIV Study-Pamboukian

  7. Selected Pre-Implant Conditions by HIV Status HIV Study-Pamboukian

  8. Causes of Death of HIV Infected Patients HIV Study-Pamboukian

  9. Comparison of HIV Infected Patients – Died vs Alive (as of 03/31/2015) HIV Study-Pamboukian

  10. Adverse Event Rates HIV Study-Pamboukian

  11. Infection Rates by Location HIV Study-Pamboukian

  12. Kaplan Meier Survival Estimates HIV Study-Pamboukian

  13. Competing Outcomes – HIV Patients HIV Study-Pamboukian

  14. Competing Outcomes - No HIV Patients HIV Study-Pamboukian

  15. Limitations • Information on CD4 counts, viral loads, drug regimens is lacking • These patients were likely highly selected and may not be generalizable HIV Study-Pamboukian

  16. Inferences • Although they were younger, HIV infected patients were implanted as destination therapy more frequently • identified as having contraindications to transplantation, immunosuppression • Analysis (25 HIV patients, June 2006 - June 2015) indicated similar survival in HIV infected patients after MCS • After implantation, infectious complications were more frequent in HIV infected patients HIV Study-Pamboukian

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