Infective endocarditis in HIV-infected patients. Analysis of a national cohort

Abstract

Background

There is limited recent evidence about infective endocarditis (IE) in HIV-infected patients. Our aim was to compare IE according to HIV infection presence.

Methods

Consecutive inclusion of IE patients at 46 Spanish hospitals between 2008 and 2021.

Results

From 5667 patients, 99 were HIV-infected (1·7%; 50 intravenous drugs users). Compared to patients without HIV, HIV-infected patients were more frequently male (84% vs. 67%), had younger median age (46 vs. 69 years), and less comorbidities, except liver disease (52% vs. 9%) and intravenous drug use (51% vs. 1%). They had more common tricuspid location (36% vs. 5%) and community-acquired IE (82% vs. 63%), vascular (29% vs. 17%) and cutaneous (22% vs. 7%) foci of infection, and Staphylococcus aureus aetiology (46% vs. 22%). Vegetations (84% vs. 72%), vascular phenomena (17% vs. 9%), splenomegaly (30% vs. 11%), and embolisation (41% vs 21%) were also more common. Surgical indication and surgery were less frequent in HIV-infected patients (54% vs 67%, 28% vs 47%, respectively). Median CD4 count in HIV-infected patients was 318 cells/mm³. In-hospital mortality (23% vs. 26%) and one-year mortality (25% vs. 32%) were similar in both groups. HIV infection was not independently associated with in-hospital (odds ratio 1·1, 95% CI 0·6–1·9) nor one-year mortality (hazard ratio 0·8, 95% CI 0·4–1·3).

Conclusions

In the combined antiretroviral therapy era, less than 2% of IE patients have HIV infection. HIV-infected patients have a different clinical profile than those without HIV, but the presence of HIV does not seem to impact on IE prognosis.

Keywords:

• Infective endocarditis
• HIV
• mortality
• prognosis

Authors’ contributions

MMS and XKU conceived and designed the analysis. MMS supervised the findings and wrote the first draft. MMS, JMM, and MAGS supervised the project and directly accessed and verified the underlying data reported in the manuscript. All authors included patients, discussed the results, provided critical feedback, contributed to the final manuscript, and had full access to all the datain the study and accept responsibility to submit for publication.

Disclosure statement

JMM has received consulting honoraria and/or research grants from Angelini, Contrafect, Cubist, Genentech, Gilead Sciences, Jansen, Lysovant, Medtronic, MSD, Novartis, Pfizer, and ViiV Healthcare, outside the submitted work. The remaining authors have nothing to disclose.

Data availability statement

GAMES database might be made available to others if requested. The direction of the Spanish Society of Cardiovascular Infections will analyse all received proposals. If approved, the database will be made available after a data access agreement is signed.

Additional information

Funding

We declare no funding for this article. JMM received a personal 80:20 research grant from Institutd’Investigacions Biomèdiques August Pi iSunyer (IDIBAPS), Barcelona, Spain, during 2017–24.