Diastolic dysfunction in people with HIV without known cardiovascular risk factors in Western Kenya

Abstract

ObjectivesDiastolic dysfunction (DD) has been reported to be highly prevalent in people living with HIV (PLWH) on antiretroviral therapy (ART) leading to the hypothesis that it may be an early marker of myocardial disease. Our objective was to evaluate the prevalence of DD in people living with human immunodeficiency virus without known history of diabetes or hypertension in Western Kenya.MethodsIn this cross-sectional study in western Kenya, 110 PLWH on ART and without known diabetes or hypertension were matched for age ±5 years and sex to HIV-uninfected controls. Study participants underwent a comprehensive two-dimensional echocardiogram and laboratory testing.ResultsThe mean (SD) age in the HIV-positive group was 42.9 (8.6) years compared with 42.1 (12.9) years in the HIV-uninfected group. Mean (SD) CD4 +T cell count for the HIV-positive group was 557 (220) cells/ml. Mean systolic and diastolic blood pressures were within the normal range and comparable between the two groups. Mean body mass index was 25.2 (5.4) kg/m2 and 26.3 (5.4) kg/m2 in HIV-positive and uninfected participants, respectively. There was only 1 (0.9 %) case of DD in each group. Despite low prevalence of DD, PLWH had 5.76 g/m2 higher left ventricular mass index (p=0.01) and 2.77 mL/m2 larger left atrial volume (p=0.02) compared with the HIV-negative group after adjusting for risk factors associated with DD.ConclusionContrary to prior reports, DD in PLWH was low. Environmental and cardiovascular disease risk factors such as diabetes and hypertension may be significant modifiers for development and progression of DD in PLWH.

Echocardiography Assessment of Cardiac Function in Adults Living with HIV: A Speckle Tracking Study in the Era of Antiretroviral Therapy

“…Echocardiographic studies have reported a high prevalence of diastolic dysfunction, ranging from 40 to 50%, in ALHIV [9,11,12]. Nevertheless, newer reports found that in individuals without cardiovascular risk factors such as diabetes or hypertension, diastolic dysfunction was almost absent [13]. In our study, the prevalence was also lower (21%), and it could be explained by the low incidence of cardiovascular risk factors in our population.…”

High rate of left ventricular hypertrophy on screening echocardiography among adults living with HIV in Malawi

“… 26–28 A recent cross-sectional study from Kenya found a low rate of diastolic dysfunction in people living with HIV and a similar rate as compared with age and sex-matched individuals without HIV; however, individuals with HIV did have significantly higher LV mass index and left atrial volume. 29 None of the participants in this study had hypertension, limiting comparisons with our study population.…”

“…Proposed mechanisms for this include chronic inflammation and immune activation, even in the setting of viral suppression23–25 and increased pericardial fat density,21 which is common in people living with HIV and has been associated with coronary artery calcification and myocardial infarction 26–28. A recent cross-sectional study from Kenya found a low rate of diastolic dysfunction in people living with HIV and a similar rate as compared with age and sex-matched individuals without HIV; however, individuals with HIV did have significantly higher LV mass index and left atrial volume 29. None of the participants in this study had hypertension, limiting comparisons with our study population.…”

Prevention of heart failure, tachyarrhythmias and sudden cardiac death in HIV

“…However, among some studies of PLWH in African nations, diastolic dysfunction is much less prevalent (1–7%) [32,33] and similar by HIV serostatus [32,33], perhaps due to younger participants, few traditional cardiac risk factors and yet unidentified differences in environmental factors. Nonetheless, left ventricular mass was higher among these younger African PLWH compared to uninfected controls which may predispose to future diastolic dysfunction [32,33]. Risk factors for left ventricular hypertrophy include CD4 count ≤200 cells/mm 3 , lack of viral suppression [29], and later initiation of ART [33], whereas lower CD4 count [29] and more severe HIV disease [33] correlate with diastolic dysfunction.…”

“…Prevalent diastolic dysfunction ranges from 22–37% among cohorts of middle-aged PLWH [10,20 ▪ ,29]. However, among some studies of PLWH in African nations, diastolic dysfunction is much less prevalent (1–7%) [32,33] and similar by HIV serostatus [32,33], perhaps due to younger participants, few traditional cardiac risk factors and yet unidentified differences in environmental factors. Nonetheless, left ventricular mass was higher among these younger African PLWH compared to uninfected controls which may predispose to future diastolic dysfunction [32,33].…”