Abstract
BACKGROUND: Evaluation of nonvalvular atrial fibrillation/atrial flutter (NVAF) in under-represented racial and ethnic minority groups (UREGs) living with HIV has not been adequately studied. OBJECTIVES: The purpose of this study was to describe the incidence of NVAF, identify associated factors, and describe oral anticoagulation (OAC) patterns among UREGs with HIV. METHODS: This is a secondary analysis of data collected in PATHWAYS (Pathways to Cardiovascular Disease Prevention and Impact of Specialty Referral in Underrepresented Racial and Ethnic Minorities with HIV; NCT04025125), a retrospective population-based study of HIV care among UREGs with HIV. We investigated the independent associations of cardiovascular and HIV-specific risk factors with incident NVAF using Cox regression analysis and examined appropriate OAC use. RESULTS: From 2015 to 2019, 11,066 UREGs with HIV met entry criteria; 10,945 were without NVAF at baseline. On average, patients were 44 years of age, 67.2% male, 94.4% Black, and 8.5% Hispanic. Average follow-up was 3.4 years, and 63.4% were on antiretroviral therapy. Incidence of NVAF was 4.54 incident cases per 1,000 person-years with a cumulative incidence at one and 5 years after HIV diagnosis of 0.48% and 2.16%, respectively. Age, diabetes, heart failure, severe renal disease, and antiretroviral therapy regimens including a protease inhibitor and/or integrase strand transfer inhibitor were independently associated with incident NVAF. Of those with NVAF meeting qualifying CHA(2)DS(2)-VASc scores, only 44.2% received any OAC prescription for stroke prophylaxis. CONCLUSIONS: In this cohort of UREGs living with HIV, both traditional and HIV-specific risk factors were associated with incident NVAF. Rates of appropriate OAC prescribing were low.