Abstract Body: Introduction
Limited data exist on physician-adjudicated heart failure (HF) phenotypes and etiologies in people with HIV (PWH), despite a 1.5-2-fold higher risk for HF for PWH compared to the general population. Using a standardized, centralized screening and adjudication protocol, we determined HF phenotypes and etiologies in PWH at five centers across the US participating in the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) cohort.

Hypotheses
Nonischemic etiologies of HF are more common in PWH than ischemic etiologies across different clinical and geographic sites.

Methods
Two physicians independently adjudicated incident HF events occurring between 1/1/2010 and 12/31/2024 at five sites across the US (Birmingham, AL; Seattle, WA; Chapel Hill, NC; San Diego, CA; and Nashville, TN). We ascertained possible HF using a protocol incorporating administrative codes and biomarkers of congestion; physician adjudicators then reviewed clinical records including notes, imaging, and laboratory reports, with confirmed HF requiring a combination of symptoms, physician diagnosis, and HF medication use. Adjudicators then determined HF subtypes based on left ventricular ejection fraction (LVEF), and presumed etiologies (e.g., ischemic and/or non-ischemic) based on systematic records review.

Results
Among 24,169 PWH across 5 CNICS sites, 460 (1.9%) had incident adjudicated HF over a mean 6.4 years of followup. Antiretroviral therapy use was common at baseline both for those with incident HF (75.2% on antiretroviral therapy) and those without incident HF (80.4%). PWH with incident HF had a higher prevalence of cardiovascular risk factors at baseline, such as hypertension (45.4% vs. 18.8%) and diabetes (19.6% vs. 6.1%), and more commonly used cocaine (15.0% vs. 8.9%). Among PWH with HF, approximately half (49.3%) had HF with reduced ejection fraction (HFrEF; LVEF<40%) and 150 (32.6%) had HF with preserved ejection fraction (HFpEF; LVEF≥50%). The majority (70.0%) had a nonischemic etiology of HF; 53.3% had nonischemic etiology only (without concomitant ischemic contributors). Only 14.1% of PWH with HF had ischemic etiology only. Patterns were consistent across sites; ischemic-only etiology comprised less than 1/3^rd of HF events for each of the 5 sites.

Conclusions
Nonischemic etiologies of HF are more common than ischemic etiologies of HF in PWH, and this finding is consistent across geographically and clinically distinct sites in the United States.