---
title: "Guideline-directed Medical Therapy for Heart Failure in People with HIV: Prescription Intensity an"
id: "pubmed-42720139"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42720139"
content_type: "clinical_feed_article"
specialty: "Infectious Disease"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42720139/"
doi: "10.1080/25787489.2026.2728496"
published_at: "2026-09-10T15:53:35.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Guideline-directed Medical Therapy for Heart Failure in People with HIV: Prescription Intensity an
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42720139
- **Specialty:** [Infectious Disease](https://medichelpline.com/clinical-feed/infectious-disease.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42720139/)
- **DOI:** [10.1080/25787489.2026.2728496](https://doi.org/10.1080%2F25787489.2026.2728496)
- **Published At:** 2026-09-10T15:53:35.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- People with **HIV** have an elevated risk of developing **heart failure (HF)** compared with people without HIV. Guideline-directed medical therapy (**GDMT**) is central to HF management, but its use and intensity in people with HIV are not well described. - The PATHWAYS study performed a retrospective, multi-institutional analysis focused on underrepresented racial and ethnic minorities with HIV to evaluate GDMT prescription among adults with systolic HF identified by ICD code. - Investigators created a composite, dosage-weighted **GDMT score** ranging from 0% to 100% to represent intensity of prescribed HF therapy, where 100% equals optimal therapy. - In a cohort of 451 people with HIV and systolic HF, median age was 54 years (IQR 47–62); 34.6% were female; 96.6% were Black. - Within one year after HF diagnosis, 85.8% of patients received at least one GDMT prescription, while 45.5% attended a cardiology clinic visit. - The cohort’s mean GDMT score was 30% (SD 22%), indicating generally low intensity of GDMT across the sample. - Multivariable analyses identified factors associated with GDMT intensity: lower scores were linked to older age (adjusted mean ratio [AMR] 0.96, 95% CI 0.93–0.99) and severe renal disease (AMR 0.84, 95% CI 0.71–0.99). - Higher GDMT scores were associated with diabetes mellitus (AMR 1.33, 95% CI 1.16–1.53), prior myocardial infarction (AMR 1.17, 95% CI 1.02–1.35), and attendance at a cardiology clinic visit (AMR 1.29, 95% CI 1.13–1.47). - The authors conclude that people with HIV and systolic HF exhibited low GDMT scores, suggesting suboptimal intensity of HF care, and that cardiology clinic attendance correlated with higher GDMT intensity. - The abstract lists key terms including **HIV**, cardiovascular disease, comorbidities, guideline-directed medical therapy, and heart failure. Specifics about GDMT components, dosing algorithm, follow-up duration beyond one year, and limitations were not reported in the abstract.
## Clinical Analysis & Structured Key Points
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Epub 2026 Sep 10. # Heart failure among people with HIV: prescription of guideline-directed medical therapy [Melissa Klein Cutshaw](https://pubmed.ncbi.nlm.nih.gov/?term=Cutshaw+MK&cauthor_id=42720139)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42720139/#full-view-affiliation-1 "Department of Medicine, Duke University, Durham, NC, USA."), [Robert Clare](https://pubmed.ncbi.nlm.nih.gov/?term=Clare+R&cauthor_id=42720139)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42720139/#full-view-affiliation-2 "Duke Clinical Research Institute, Durham, NC, USA."), [Karen Chiswell](https://pubmed.ncbi.nlm.nih.gov/?term=Chiswell+K&cauthor_id=42720139)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42720139/#full-view-affiliation-2 "Duke Clinical Research Institute, Durham, NC, USA."), [Paul Hofmann](https://pubmed.ncbi.nlm.nih.gov/?term=Hofmann+P&cauthor_id=42720139)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42720139/#full-view-affiliation-2 "Duke Clinical Research Institute, Durham, NC, USA."), [April C Pettit](https://pubmed.ncbi.nlm.nih.gov/?term=Pettit+AC&cauthor_id=42720139)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42720139/#full-view-affiliation-3 "Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA."), [Eric Meissner](https://pubmed.ncbi.nlm.nih.gov/?term=Meissner+E&cauthor_id=42720139)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42720139/#full-view-affiliation-4 "Department of Medicine, Medical University of South Carolina, Charleston, SC, USA."), [Matthew S Durstenfeld](https://pubmed.ncbi.nlm.nih.gov/?term=Durstenfeld+MS&cauthor_id=42720139)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42720139/#full-view-affiliation-5 "Department of Medicine, University of California Los Angeles, Los Angeles, CA, USA."), [Christopher T Longenecker](https://pubmed.ncbi.nlm.nih.gov/?term=Longenecker+CT&cauthor_id=42720139)[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42720139/#full-view-affiliation-6 "Department of Global Health & Division of Cardiology, University of Washington School of Medicine, Seattle, WA, USA."), [Gerald S Bloomfield](https://pubmed.ncbi.nlm.nih.gov/?term=Bloomfield+GS&cauthor_id=42720139)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42720139/#full-view-affiliation-1 "Department of Medicine, Duke University, Durham, NC, USA.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42720139/#full-view-affiliation-2 "Duke Clinical Research Institute, Durham, NC, USA.")[ 7 ](https://pubmed.ncbi.nlm.nih.gov/42720139/#full-view-affiliation-7 "Duke Global Health Institute, Durham, NC, USA."), [Nwora Lance Okeke](https://pubmed.ncbi.nlm.nih.gov/?term=Okeke+NL&cauthor_id=42720139)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42720139/#full-view-affiliation-1 "Department of Medicine, Duke University, Durham, NC, USA.") Affiliations Expand ### Affiliations * 1 Department of Medicine, Duke University, Durham, NC, USA. * 2 Duke Clinical Research Institute, Durham, NC, USA. * 3 Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA. * 4 Department of Medicine, Medical University of South Carolina, Charleston, SC, USA. * 5 Department of Medicine, University of California Los Angeles, Los Angeles, CA, USA. * 6 Department of Global Health & Division of Cardiology, University of Washington School of Medicine, Seattle, WA, USA. * 7 Duke Global Health Institute, Durham, NC, USA. * PMID: **42720139** * DOI: [ 10.1080/25787489.2026.2728496 ](https://doi.org/10.1080/25787489.2026.2728496) Item in Clipboard Multicenter Study # Heart failure among people with HIV: prescription of guideline-directed medical therapy Melissa Klein Cutshaw et al. HIV Res Clin Pract. 2026. Show details Display options Display options Format Abstract PubMed PMID HIV Res Clin Pract Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22HIV+Res+Clin+Pract%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22HIV+Res+Clin+Pract%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42720139/) . 2026 Dec 31;27(1):2728496. doi: 10.1080/25787489.2026.2728496. Epub 2026 Sep 10. ### Authors [Melissa Klein Cutshaw](https://pubmed.ncbi.nlm.nih.gov/?term=Cutshaw+MK&cauthor_id=42720139)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42720139/#short-view-affiliation-1 "Department of Medicine, Duke University, Durham, NC, USA."), [Robert Clare](https://pubmed.ncbi.nlm.nih.gov/?term=Clare+R&cauthor_id=42720139)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42720139/#short-view-affiliation-2 "Duke Clinical Research Institute, Durham, NC, USA."), [Karen Chiswell](https://pubmed.ncbi.nlm.nih.gov/?term=Chiswell+K&cauthor_id=42720139)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42720139/#short-view-affiliation-2 "Duke Clinical Research Institute, Durham, NC, USA."), [Paul Hofmann](https://pubmed.ncbi.nlm.nih.gov/?term=Hofmann+P&cauthor_id=42720139)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42720139/#short-view-affiliation-2 "Duke Clinical Research Institute, Durham, NC, USA."), [April C Pettit](https://pubmed.ncbi.nlm.nih.gov/?term=Pettit+AC&cauthor_id=42720139)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42720139/#short-view-affiliation-3 "Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA."), [Eric Meissner](https://pubmed.ncbi.nlm.nih.gov/?term=Meissner+E&cauthor_id=42720139)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42720139/#short-view-affiliation-4 "Department of Medicine, Medical University of South Carolina, Charleston, SC, USA."), [Matthew S Durstenfeld](https://pubmed.ncbi.nlm.nih.gov/?term=Durstenfeld+MS&cauthor_id=42720139)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42720139/#short-view-affiliation-5 "Department of Medicine, University of California Los Angeles, Los Angeles, CA, USA."), [Christopher T Longenecker](https://pubmed.ncbi.nlm.nih.gov/?term=Longenecker+CT&cauthor_id=42720139)[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42720139/#short-view-affiliation-6 "Department of Global Health & Division of Cardiology, University of Washington School of Medicine, Seattle, WA, USA."), [Gerald S Bloomfield](https://pubmed.ncbi.nlm.nih.gov/?term=Bloomfield+GS&cauthor_id=42720139)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42720139/#short-view-affiliation-1 "Department of Medicine, Duke University, Durham, NC, USA.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42720139/#short-view-affiliation-2 "Duke Clinical Research Institute, Durham, NC, USA.")[ 7 ](https://pubmed.ncbi.nlm.nih.gov/42720139/#short-view-affiliation-7 "Duke Global Health Institute, Durham, NC, USA."), [Nwora Lance Okeke](https://pubmed.ncbi.nlm.nih.gov/?term=Okeke+NL&cauthor_id=42720139)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42720139/#short-view-affiliation-1 "Department of Medicine, Duke University, Durham, NC, USA.") ### Affiliations * 1 Department of Medicine, Duke University, Durham, NC, USA. * 2 Duke Clinical Research Institute, Durham, NC, USA. * 3 Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA. * 4 Department of Medicine, Medical University of South Carolina, Charleston, SC, USA. * 5 Department of Medicine, University of California Los Angeles, Los Angeles, CA, USA. * 6 Department of Global Health & Division of Cardiology, University of Washington School of Medicine, Seattle, WA, USA. * 7 Duke Global Health Institute, Durham, NC, USA. * PMID: **42720139** * DOI: [ 10.1080/25787489.2026.2728496 ](https://doi.org/10.1080/25787489.2026.2728496) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID ## Abstract **Background:** People with HIV have an increased risk of heart failure (HF) compared to people without HIV. Guideline-directed medical therapy (GDMT) is the cornerstone of HF management, but little is known about GDMT prescription in this high-risk population. **Objective:** To evaluate GDMT intensity and identify patient factors associated with optimal HF therapy among people with HIV and systolic HF. **Methods:** We conducted retrospective analyses of the PATHWAYS study, a multi-institutional study of underrepresented racial and ethnic minorities with HIV. Adult patients with systolic HF (by ICD code) were included. A composite GDMT score was constructed using dosage-weighted prescription of GDMT drugs, ranging from 0% to 100% (with 100% indicating optimal therapy). **Results:** Among 451 PWH with systolic HF, the median age was 54 years (IQR = 47-62), 34.6% were female, and 96.6% were Black. In the year after HF diagnosis, 85.8% of patients were prescribed any GDMT, and 45.5% of patients attended a cardiology clinic visit. The mean GDMT score was 30% (SD = 22%). In multivariable analyses, lower GDMT scores occurred among patients with older age (adjusted mean ratio [AMR] = 0.96, 95% CI: 0.93-0.99) and severe renal disease (AMR = 0.84, 95% CI: 0.71-0.99). Higher GDMT scores occurred among patients with diabetes mellitus (AMR = 1.33, 95% CI: 1.16-1.53), prior myocardial infarction (AMR = 1.17, 95% CI: 1.02-1.35), and those who attended a cardiology clinic visit (AMR = 1.29, 95% CI: 1.13-1.47). **Conclusions:** People with HIV and HF had low GDMT scores, suggesting suboptimal intensity of HF care. Cardiology clinic attendance was associated with higher GDMT scores. **Keywords:** HIV; cardiovascular disease; comorbidities; guideline-directed medical therapy; heart failure. 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