March 03, 2014
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Echocardiographic abnormalities more likely among ART-naive patients with HIV

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Patients with HIV and naive to antiretroviral therapy had a higher prevalence of echocardiographic abnormalities compared with healthy controls, researchers with the Chinese Academy of Medical Sciences have found.

“Our data support the hypothesis that HIV can play a role in the genesis of cardiac dysfunction,” the researchers wrote in Clinical Infectious Diseases. “No significant change in echocardiographic abnormalities was noted after 48 weeks of ART and longer prospective studies are warranted.”

This study included patients with HIV who were enrolled in the China AIDS Clinical Trial 0810 (CACT0810) from January to November 2009. Patients enrolled in CACT0810 underwent resting echocardiography before initiating ART and after 48 weeks of treatment. This substudy included 325 patients who had echocardiographic data available and age- and gender-matched HIV-negative controls. Patients with documented cardiovascular disease (CVD) or cardiac symptoms were excluded.

Twenty-four of the patients (7.3%) had left ventricular systolic dysfunction (LVSD) and most had mild disease. The prevalence of LVSD in controls was 2.1% (P=.056). There were 279 patients with HIV who underwent complete diastolic dysfunction evaluation at baseline, and 46 (16.5%) met the criteria for diastolic dysfunction, which was mild in 29 patients and moderate in 14. The prevalence among those with HIV was higher than among controls (7.2%; P=.027).

After 48 weeks of ART, the prevalence of LVSD was 9.9% among patients with HIV, and there was no significant difference in the prevalence compared with baseline. The prevalence of diastolic dysfunction was 28.3% after 48 weeks of ART, a slightly higher prevalence than at baseline (P=.056).

At baseline, age was the only risk factor associated with LVSD. HIV, age and hypertension were risk factors for diastolic dysfunction. HIV and hypertension also were associated with increased left ventricular mass. Among those with HIV, age was the only risk factor associated with LVSD (OR=1.077; 95% CI, 1.026-1.131) and diastolic dysfunction (OR=1.13; 95% CI, 1.081-1.181).

“Traditional cardiovascular factors have been reported to contribute to CVD in [people with HIV] and dyslipidemia and diabetes have been regarded as CVD risk factors in general population,” the researchers wrote. “In our study, multiple logistic regression analysis in [people with HIV] shows that only age was risk factor of LVSD and other CVD risk factors, such as hypertension, dyslipidemia and diabetes are not associated with echocardiographic abnormalities.”

Disclosure: The researchers report no relevant financial disclosures.