Sudden Cardiac Death and Myocardial Fibrosis, Determined by Autopsy, in Persons with HIV

This postmortem study investigated sudden cardiac death and myocardial fibrosis in HIV-positive individuals using forensic autopsy data from San Francisco County (2011–2016). Among 1379 deaths in HIV-positive adults, 109 were attributed to out-of-hospital cardiac arrest; 48 met World Health Organization criteria for presumed sudden cardiac death. Of these, only 22 (47%) were confirmed as arrhythmic by autopsy. The incidence of presumed sudden cardiac death in HIV-positive persons was 53.3 per 100,000 person-years versus 23.7 in HIV-negative individuals (incidence rate ratio 2.25). Autopsy revealed occult drug overdose as the most frequent cause of sudden death in HIV-positive patients (34% vs. 13% in controls). Quantitative histologic analysis showed significantly elevated levels of myocardial interstitial fibrosis among HIV-positive decedents, independent of comorbid structural heart disease. Findings suggest increased arrhythmic vulnerability associated with cardiac fibrosis in HIV and emphasize the importance of autopsy-based adjudication. Approximately half of presumed cardiac deaths were non-arrhythmic, underscoring limitations of conventional classification.

This postmortem study investigated sudden cardiac death and myocardial fibrosis in HIV-positive individuals using forensic autopsy data from San Francisco County (2011–2016). Among 1379 deaths in HIV-positive adults, 109 were attributed to out-of-hospital cardiac arrest; 48 met World Health Organization criteria for presumed sudden cardiac death. Of these, only 22 (47%) were confirmed as arrhythmic by autopsy. The incidence of presumed sudden cardiac death in HIV-positive persons was 53.3 per 100,000 person-years versus 23.7 in HIV-negative individuals (incidence rate ratio 2.25). Autopsy revealed occult drug overdose as the most frequent cause of sudden death in HIV-positive patients (34% vs. 13% in controls). Quantitative histologic analysis showed significantly elevated levels of myocardial interstitial fibrosis among HIV-positive decedents, independent of comorbid structural heart disease. Findings suggest increased arrhythmic vulnerability associated with cardiac fibrosis in HIV and emphasize the importance of autopsy-based adjudication. Approximately half of presumed cardiac deaths were non-arrhythmic, underscoring limitations of conventional classification.