• Zian H Tseng, Ellen Moffatt, Anthony Kim, Eric Vittinghoff, Phil Ursell, Andrew Connolly, Jeffrey E Olgin, Joseph K Wong, and Priscilla Y Hsue.
• From the Section of Cardiac Electrophysiology, Cardiology Division, Department of Medicine (Z.H.T., J.E.O.), the Departments of Neurology (A.K.), Epidemiology and Biostatistics (E.V.), and Pathology (P.U., A.C.), the Division of Infectious Disease, Veterans Affairs Medical Center (J.K.W.), and the Division of Cardiology, Zuckerberg San Francisco General Hospital (P.Y.H.), University of California, San Francisco, and the Office of the Chief Medical Examiner, City and County of San Francisco (E.M.) - all in San Francisco.
• N. Engl. J. Med. 2021 Jun 17; 384 (24): 2306-2316.

BackgroundThe incidence of sudden cardiac death and sudden death caused by arrhythmia, as determined by autopsy, in persons with human immunodeficiency virus (HIV) infection has not been clearly established.MethodsBetween February 1, 2011, and September 16, 2016, we prospectively identified all new deaths due to out-of-hospital cardiac arrest among persons 18 to 90 years of age, with or without known HIV infection, for comprehensive autopsy and toxicologic and histologic testing. We compared the rates of sudden cardiac death and sudden death caused by arrhythmia between groups.ResultsOf 109 deaths from out-of-hospital cardiac arrest among 610 unexpected deaths in HIV-positive persons, 48 met World Health Organization criteria for presumed sudden cardiac death; of those, fewer than half (22) had an arrhythmic cause. A total of 505 presumed sudden cardiac deaths occurred between February 1, 2011, and March 1, 2014, in persons without known HIV infection. Observed incidence rates of presumed sudden cardiac death were 53.3 deaths per 100,000 person-years among persons with known HIV infection and 23.7 deaths per 100,000 person-years among persons without known HIV infection (incidence rate ratio, 2.25; 95% confidence interval [CI], 1.37 to 3.70). Observed incidence rates of sudden death caused by arrhythmia were 25.0 and 13.3 deaths per 100,000 person-years, respectively (incidence rate ratio, 1.87; 95% CI, 0.93 to 3.78). Among all presumed sudden cardiac deaths, death due to occult drug overdose was more common in persons with known HIV infection than in persons without known HIV infection (34% vs. 13%). Persons who were HIV-positive had higher histologic levels of interstitial myocardial fibrosis than persons without known HIV infection.ConclusionsIn this postmortem study, the rates of presumed sudden cardiac death and myocardial fibrosis were higher among HIV-positive persons than among those without known HIV infection. One third of apparent sudden cardiac deaths in HIV-positive persons were due to occult drug overdose. (Supported by the National Heart, Lung, and Blood Institute.).Copyright © 2021 Massachusetts Medical Society.

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