Conference Coverage

Patients with HIV Show Lower In-Hospital Mortality After Device-Related Endocarditis

Kate Young

Key Clinical Summary

  • National inpatient analysis (2016–2022) found lower in-hospital mortality among patients with HIV and cardiac implantable electronic device–related infective endocarditis.
  • Patients with HIV had reduced rates of acute kidney injury, cerebrovascular accidents, and device extraction.
  • No significant differences in hospital stay length or total hospitalization costs were observed between HIV-positive and HIV-negative groups.

A new analysis presented at the 2025 American Heart Association (AHA) Scientific Sessions reveals that patients with HIV hospitalized with cardiac implantable electronic device–related infective endocarditis (CIED-IE) experienced lower in-hospital mortality than patients without HIV. The study, led by investigators from Ascension Saint Joseph Hospital in Chicago, examined national-level data to assess outcomes in this population.

Study Findings

Researchers used data from the National Inpatient Sample (NIS) between 2016 and 2022, identifying adult hospitalizations with a primary or secondary diagnosis of CIED-IE using validated ICD-10 codes. HIV status was determined from diagnosis fields, and 1:1 nearest neighbor propensity score matching was performed to balance baseline demographics and comorbidities.

The final analysis included 569 matched pairs with a mean age of 52.7 years (SD = 12) and 37.3% female. The cohort was 75% Black, 15.7% White, 6.6% Hispanic, and 0.4% Asian or Pacific Islander.

In-hospital mortality was significantly lower among HIV-positive patients compared with HIV-negative patients (2.3% vs 6.0%, P = .026). Kaplan-Meier survival analysis showed a lower in-hospital mortality risk (HR = 0.48, 95% CI [0.25–0.91], P = .026). There were no significant differences in length of stay or hospitalization costs between the two groups.

Patients with HIV also had lower rates of acute kidney injury (OR = 0.62, P = .01), device extraction (OR = 0.47, P = .03), and cerebrovascular accidents (HR = 0.39, P = .026).

Clinical Implications

The findings challenge prior assumptions that HIV infection worsens outcomes in serious cardiac infections. Improvements in HIV management and antiretroviral therapy may have contributed to enhanced resilience and reduced mortality in this population.

Comparable hospital stays and costs suggest that patients with HIV and CIED-IE do not incur greater inpatient burden, reinforcing the effectiveness of current multidisciplinary approaches to infection management. Clinicians can draw from this evidence that HIV status alone may not independently predict adverse outcomes in device-related infective endocarditis, underscoring the importance of equitable, guideline-based care across populations.

Expert Commentary

As the study authors concluded, “Among hospitalized patients with CIED-IE, HIV-positive patients have significantly lower in-hospital mortality with no significant differences in hospital length of stay and costs. In addition, HIV patients have lower rates of complications of CIED-IE such as AKI, device extraction, and cerebrovascular accidents.”

This national matched analysis demonstrates that patients with HIV and device-related infective endocarditis experience lower mortality and complication rates without increased hospital burden. The findings highlight evolving outcomes for individuals with HIV in the context of advanced infection and cardiac care.

Reference
Gebrecherkos Y, Haroun M, Weldehana AM, Siraw BB, Paudel H, Yasmeen J, Sharma S. Outcomes of HIV-positive patients with cardiac implantable electronic device–related infective endocarditis (CIED-IE): a propensity score–matched analysis of national inpatient sample data (2016–2022). Presented at: American Heart Association (AHA) Scientific Sessions; November 8, 2025; Chicago, IL.