Incidence and risk factors of atrial fibrillation and atrial arrhythmias in people living with HIV: a systematic review and meta-analysis

Background: Cardiovascular diseases in people living with HIV (PLWH) are becoming increasingly relevant as HIV/AIDS has become more treatable with the advent of highly efficacious antiretroviral therapy. Previous studies suggested that HIV infection is an independent risk factor for atrial arrhythmia. This study aims to collectively analyze these studies to elucidate the incidence and risk factors of atrial arrhythmia in PLWH.

Methods: Full-text assessments and data extraction were performed from available literature. Atrial arrhythmia was defined as atrial fibrillation or atrial flutter. Incidence rate, risk, and potential risk factors of atrial arrhythmia in PLWH were catalogued, after which random-effects models were used to estimate pooled summary statistics. PRISMA standardized meta-analysis guidelines were followed.

Results: Analysis of 94,928 PLWH had an averaged incidence rate of 6.4 cases of atrial arrhythmia per 1000 person-years. Risk of atrial arrhythmia was significantly higher in PLWH than in the general population (RR 1.35; 95% CI 1.19-1.53). Sex had no association with the risk of incidental atrial arrhythmia in PLWH (RR 1.47; 95% CI 0.95-2.28). Black race (RR 0.68; 95% CI 0.47-0.97) was associated with decreased risk, whereas lower CD4 counts (RR 1.80; 95% CI 1.18-2.77) and increased viral load (RR 1.57; 95% CI 1.19-2.09) suggested increased risk of atrial arrhythmia in PLWH.

Conclusions: HIV infection is a risk factor of atrial arrhythmia. Providers should be aware of the increased burden of atrial arrhythmia in PLWH and continue to encourage treatment of HIV infection while managing cardiovascular risk factors and screening for arrhythmias in symptomatic patients.