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- Background: Persons living with HIV (PLWH) have approximately double the risk of cardiovascular disease (CVD) compared to those without HIV. Despite Tanzania’s impressive strides in expanding access to HIV testing, one in five PLWH in Tanzania are unaware of their status. The purpose of our study was to determine the prevalence of diagnosed and undiagnosed HIV among patients presenting to a Tanzanian emergency department with acute myocardial infarction (MI) or heart failure (HF). Methods: This was a prospective observational study. Adults presenting to a northern Tanzanian emergency department with acute chest pain or shortness of breath were enrolled from November 2020 to January 2023. Patients with no known history of HIV underwent testing via SD Bioline HIV 1/2 assay and confirmatory testing via Uni-Gold Recombigen HIV 1/2 assay. Acute MI was defined as per Fourth Universal Definition criteria. HF was defined as physician documented diagnosis at hospital discharge. Thirty-day follow-up was conducted via telephone or home visit.
Results: We screened 10,064 patients and enrolled 836 (8.3%). Of these, 344 (41.1%) participants met the study definitions for AMI or acute HF. Of these, 16 (4.7%) had HIV, including 15 known cases of HIV and 1 case of newly diagnosed HIV. Of participants without acute MI or HF, 17(3.5%) had HIV, all of which were known cases. Follow-up was achieved for most (n=834, 99.8%) participants. Participants with HIV were significantly more likely to die within 30 days following diagnosis of acute MI or HF than participants without HIV (37.5% vs 24.5%, OR 1.93, 95% CI: 1.05-3.60, p<0.05).
Conclusions: Targeted, point-of-care HIV testing for patients presenting with cardiovascular complaints in a northern Tanzania ED setting may not be a high-yield method for identifying new cases of HIV. Future studies are needed to assess the utility of HIV testing in patient populations with a high burden of HIV. Thirty-day mortality following acute MI or HF diagnosis is significantly higher for HIV-infected participants, emphasizing the need for interventions to address poor clinical outcomes of CVD among PLWH in Tanzania.
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