The prevalence of HIV among patients with cardiovascular disease in a Tanzanian emergency department: results from a prospective observational study.

OBJECTIVES: Persons living with HIV (PLWH) face double the risk of cardiovascular disease (CVD) compared to others. We assessed HIV prevalence among patients presenting to a Tanzanian emergency department (ED) with acute myocardial infarction (AMI) or heart failure (HF). METHODS: In this prospective observational study (Nov 2020-Jan 2023), adults with chest pain or dyspnea were enrolled. Patients without known HIV underwent HIV 1/2 assay and confirmatory testing. AMI was defined per the Fourth Universal Definition; HF by physician diagnosis at discharge. Thirty-day follow-up was via phone or home visit. RESULTS: Of 836 enrolled participants, 344 (41.1%) met criteria for AMI or HF. Among these, 16 (4.7%) had HIV (15 known, 1 new). In participants without AMI or HF, 17 (3.5%) had known HIV. Follow-up was achieved for 99.8% (n = 834). HIV-positive participants with AMI or HF had higher unadjusted 30-day mortality than HIV-negative participants (37.5% vs 24.5%, OR 1.93, 95% CI: 1.05-3.60, p < 0.05). CONCLUSIONS: Targeted HIV testing for patients with cardiovascular complaints in a Tanzanian ED setting may not be a high-yield method for identifying new HIV cases. Future studies should be tailored to populations underrepresented in current programs. Thirty-day mortality following AMI or HF diagnosis is significantly higher for PLWH in Tanzania, emphasizing the need for interventions to address poor clinical outcomes of CVD among this population.

Duke Scholars

Author Julian T Hertz Emergency Medicine

Author Nathan Maclyn Thielman Medicine, Infectious Diseases