Out-of-Hospital Cardiac Arrest in individuals with Human Immunodeficiency Virus infection: A nationwide population-based cohort study

BACKGROUND: Little data exist on the risk and outcomes of out-of-hospital cardiac arrest (OHCA) in people with HIV (PWH). We aimed to describe OHCA in PWH as compared to the general population in terms of incidence, characteristics, and survival.

METHODS: This nationwide study assessed all individuals aged 18-85 years between 2001 and 2019 in Denmark. Cumulative incidence of OHCA was computed using cause-specific Cox models accounting for competing risk of death.

RESULTS: Among 6 565 309 individuals, 6 925 (median age 36 [IQR 28-44], 74% males) were infected at some point with HIV. Incidence of OHCA was 149 (95% CI 123-180)/100 000 person-years in PWH versus 64 (95% CI 64-65)/100 000 person-years in non-HIV patients (P<0.001). Age at the time of cardiac arrest was 52 (IQR 44-61) years in PWH (vs. 69 [IQR 59-77] years in individuals without HIV; P<0.001). In a multivariable model adjusted for age, sex, hypertension, diabetes, heart failure, ischemic heart disease, atrial fibrillation, chronic obstructive pulmonary disease, cancer and renal failure, PWH had a two-fold higher risk of OHCA (HR 2.84, 95% CI 2.36-3.43; P<0.001). Thirty-day mortality (89% vs 88%; P=0.80) was comparable to individuals without HIV.

CONCLUSIONS: HIV is an independent risk factor of OHCA and OHCA victims with HIV are much younger than those without HIV. Almost 90% of PWH died one month after OHCA. Further research should strive to find out how to reduce OHCA occurrence in this population.