Ibrahim, Ramzi

Background: HIV cardiomyopathy (HIV-CM) is associated with significant morbidity and mortality. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have benefits in heart failure (HF), but their role in the specialized population of HIV-CM is poorly understood. Methods: Patients in the TriNetX Network with HIV-CM and SGLT2i therapy were compared to a propensity matched control group of patients with HIV-CM without SGLT2i use. The primary endpoint was all-cause mortality. Secondary endpoints included all-cause hospitalization, acute heart failure (HF), acute myocardial infarction (MI), stroke, cardiac arrest, new atrial fibrillation, and ventricular tachycardia. Results: In the total of 2,606 included patients, SGLT2i therapy was associated with significant reduction in all-cause mortality (HR 0.475, 95%CI 0.337–0.671) and all-cause hospitalization (HR 0.725, 95%CI 0.646–0.814). No significant differences were observed rates of acute HF (HR 1.111, 95% CI 0.957–1.289), myocardial infarction (HR 0.828, 95% CI 0.555-1.235), stroke (HR 0.995, 95% CI 0.747–1.327), cardiac arrest (HR 0.564, 95% CI 0.308-1.036), atrial fibrillation (HR 0.954, 95% CI 0.798–1.140), or ventricular tachycardia (HR 1.225, 95% CI 0.898–1.672). Conclusions: SGLT2i use was associated with significant reductions in all-cause mortality and hospitalizations in patients with HIV-CM, but not cardiac specific outcomes.