Cardiac dysfunction prevalent in patients with HIV
Patients with HIV were more likely to have cardiac dysfunction, according to a systematic review and meta-analysis published in JACC: Heart Failure.
“Together, these data suggest that early detection of cardiac dysfunction in [people living with HIV] could provide a window of opportunity in which it may be possible to institute intervention to reverse the course, as has been proposed for individuals in the general population with asymptomatic cardiac dysfunction,” Sebhat Erqou, MD, PhD, assistant professor of medicine at Brown University Alpert Medical School in Providence, Rhode Island, and staff cardiologist at VA Providence Medical Center and Lifespan Cardiovascular Institute in Providence, and colleagues wrote.
Patients with HIV, cardiac dysfunctions
Researchers analyzed data from 63 reports from 54 studies with up to 125,382 patients with HIV and 12,655 cases of various cardiac dysfunctions, including HF, left ventricular systolic dysfunction, dilated cardiomyopathy, diastolic dysfunction, pulmonary hypertension or right ventricular dysfunction.
Of the patients included in the meta-analysis, the pooled prevalence for LV systolic dysfunction was 12.3% and 12% for dilated cardiomyopathy. The pooled prevalence for grades I to III diastolic dysfunction was 29.3% and 11.7% for diastolic dysfunction grades II to III. Clinical HF had a pooled incidence of 0.9 per 100 person-years and a prevalence of 6.5%. The combined prevalence of right ventricular dysfunction was 8% and 11.5% for pulmonary hypertension.
The outcomes analyzed in all of the studies had significant heterogeneity (I2 > 70%; P < .01), which may be partially explained by the available study level characteristics.
Prevalence of LV systolic dysfunction
There was a lower prevalence of LV systolic dysfunction in the studies that reported high use of antiretroviral therapy or fewer patients with AIDS, the researchers wrote. In addition, there was a higher prevalence of LV systolic dysfunction in the African region. The prevalence of LV systolic dysfunction was lower in studies that were published more recently after taking into account the regional variation effect.
“The substantial risk of various types of cardiac dysfunction in [people living with HIV] helps create awareness within the medical community caring for these patients to watch for complications and implement early intervention when indicated,” Erqou and colleagues wrote. “In addition to subclinical cardiac dysfunction identified using imaging modalities, [people living with HIV] have materially increased risk of clinical HF, indicating that asymptomatic cardiac dysfunction identified on imaging can be progressive in a subset of participants.”
In a related editorial, Christopher R. deFilippi, MD, member of the Inova Heart and Vascular Institute in Falls Church, Virginia, and Steven K. Grinspoon, MD, director of Massachusetts General Hospital Program in Nutritional Metabolism and of the Nutrition Obesity Research Center at Harvard Medical School, wrote: “Similar to the prevention of atherosclerotic disease in [people living with HIV], development of prevention strategies for HF is an imperative for those infected with HIV to continue to enjoy hard-won victories to improve duration and quality of life.” – by Darlene Dobkowski
Disclosures: The authors report no relevant financial disclosures. DeFilippi reports he received grants through his institution from Roche Diagnostics, consults for Abbott Diagnostics, FujiRebio, Metabolomics, OrthoDiagnostics, Roche Diagnostics and Siemens Healthcare, received honoraria from WebMD and received royalties from UpToDate. Grinspoon reports he is a consultant for Theratechnologies and received research funding from Gilead, KOWA, Navidea and Theratechnologies.