HIV is associated with subtle impairments in left ventricular function: insights from a large prospective cohort study of well-treated people with HIV
Authors: Reimer Jensen A M , Duus L S , Vyff F , Johansen N D , Sengelov M , Olsen F J , Knudsen A D , Alhakak A S , Vesterlev D , Davidovski F S , Lassen M H , Skaarup K G , Linde J J , Nielsen S D , Biering-Sorensen T 
Published: October 2024

Abstract

Background
Human Immunodeficiency Virus (HIV) has become a treatable, chronic condition, but people with HIV still face an elevated risk of cardiovascular disease, including heart failure.

Purpose
To assess echocardiographic alterations in left ventricular (LV) function in a contemporary cohort of well-treated people with HIV compared to the general population.

Methods
We included 744 people with HIV frequency matched 1:1 on age and sex with controls from the general population. Both people with HIV and controls underwent echocardiography, physical examination, questionnaires and blood sampling according to similar study protocols.
LV systolic dysfunction was defined as LV ejection fraction (LVEF) &lt;50% or absolute global longitudinal strain (GLS) &lt;16%. LV diastolic function was defined as abnormal if the following was true for half or more available parameters: (1) average E/e’&gt;14, (2) septal e’ velocity &lt; 7 cm/s or lateral e’ velocity &lt;10cm/s, (3) tricuspid regurgitation velocity &gt;2.8 m/s, (4) left atrial volume index &gt;34ml/m2.
Associations between HIV status and LV function were assessed using linear and logistic regression models adjusted for age, sex, smoking, hypertension, diabetes mellitus, total cholesterol and high-sensitivity C-reactive protein. Among people with HIV, the association between HIV-specific characteristics and LV function were assessed using logistic regression models with adjustment for the same potential confounders.

Results
Mean age was 53.4 years and 88% were male. For people with HIV, median time since HIV diagnosis was 18 years and 99% received antiretroviral therapy. People with HIV had lower adjusted mean absolute GLS [17.6 vs. 18.5%, p&lt;0.001], E/A ratio [1.0 vs. 1.2, p&lt;0.001] and average e’ [9.5 vs. 10.5 cm/s, p&lt;0.001] than controls, while LVEF and E/e’ were not significantly different between people with HIV and controls (Figure 1). HIV was associated with impaired systolic function as assessed by GLS [odds ratio 1.70, 95% CI: 1.17-2.46, p=0.005], but not when assessed by LVEF [odds ratio 1.06, 95% CI: 0.78-1.45, p=0.69](Figure 2). Living with HIV was not associated with diastolic dysfunction compared to controls [odds ratio 0.97, 95% CI: 0.61-1.52, p=0.88], but longer HIV-duration was associated with higher odds of diastolic dysfunction among people with HIV (odds ratio 1.06, 95% CI: 1.02-1.10 per year, p=0.004). Current antiretroviral medication type, previous AIDS defining conditions, current CD4+ count and detectable viral load were not associated with LV dysfunction.

Conclusion
People with HIV show signs of early impairments in longitudinal LV systolic function compared to the general population. These subclinical changes may underlie the increased risk of heart failure observed in PWH.