Human Immunodeficiency Virus–Associated Myocardial Diastolic Dysfunction and Soluble ST2 Concentration in Tanzanian Adults: A Cross-Sectional Study

Abstract

<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Background</jats:title> <jats:p>The aims of this study were (1) to compare the prevalence of myocardial diastolic dysfunction (DD) in antiretroviral therapy (ART)–naive people living with human immunodeficiency virus (PLWH) to human immunodeficiency virus (HIV)–uninfected adults in East Africa and (2) to determine the association between serum concentration of the cardiac biomarkers ST2 and DD.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>In this cross-sectional study, we enrolled PLWH and uninfected adults at a referral HIV clinic in Mwanza, Tanzania. Standardized history, echocardiography, and serum were obtained. Regression models were used to quantify associations.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>We enrolled 388 ART-naive PLWH and 461 HIV-uninfected adults with an average age of 36.0 ± 10.2 years. Of PLWH in the third, fourth, and fifth decades of life, 5.0%, 12.5%, and 32.7%, respectively, had DD. PLWH had a higher prevalence of DD (adjusted odds ratio, 2.71 [95% confidence interval, 1.62–4.55]; P &amp;lt; .0001). PLWH also had a higher probability of dysfunction with one or fewer traditional risk factors present. Serum ST2 concentration was associated with dysfunction in PLWH but not uninfected participants (P = .04 and P = .90, respectively).</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>In a large population of young adults in sub-Saharan Africa, DD prevalence increased starting in the third decade of life. HIV was independently associated with dysfunction. Serum ST2 concentration was associated with DD in PLWH but not HIV-uninfected participants. This pathway may provide insight into the mechanisms of HIV-associated dysfunction.</jats:p> </jats:sec>

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

“…The majority of studies evaluating the prevalence of DD have been reported from developed countries where the prevalence of cardiovascular risk factors such as diabetes, hypertension, metabolic syndrome, IV drug use and mode of HIV infection are different 7 13. Studies in sub-Saharan Africa on the other hand have included symptomatic,38 hospitalised or untreated PLWH with advanced immune dysfunction 24 25. In our study of ART-treated PLWH with relatively normal CD4 +T cell counts, we specifically sought to enrol participants without known cardiovascular risk factors of diabetes or hypertension which promote DD.…”

“…Prior studies linking HIV to DD have focused on PLWH with greater burden of comorbid conditions12 such as diabetes and hypertension,12 13 20 21 hepatitis C infection13 22 23 that confound the true association of DD with HIV infection. Similarly, the limited studies from Africa evaluating asymptomatic PLWH have included untreated cohorts24 25 or PLWH with high prevalence of cardiac comorbidities20 24 strongly associated with DD. The objective of this study was to characterise the prevalence of DD in ART treated PLWH in Kenya and a matched HIV-uninfected (HIV neg ) group, without known risk factors of diabetes and hypertension.…”

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

“…However, there are few studies that evaluate associations between blood pressure control and LVH or LV dysfunction. Cross-sectional studies from Africa have found that people living with HIV have higher LV mass5 21 and higher rates of diastolic dysfunction9 21 even in the absence of hypertension and other cardiovascular risk factors, suggesting that HIV itself may independently contribute to increased LV mass and LV dysfunction 10 22. 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.…”

“…HIV is associated with an increased risk for structural heart disease, including altered cardiac chamber size and volume4 5 and diastolic dysfunction 6 7. Changes in left ventricular (LV) mass and diastolic dysfunction have been described in studies of people living with HIV even when controlling for age, sex, ART and cardiovascular risk factors 8–10. Data on structural heart disease and associated risk factors in people living with HIV in sub-Saharan Africa remain limited as a result of poor availability of echocardiography, which has been challenging to provide as part of routine care due to lack of equipment and limited expertise to perform echocardiograms and interpret findings.…”

New Biomarkers and Their Potential Role in Heart Failure Treatment Optimisation—An African Perspective

“…A sizeable cross-sectional Tanzanian study enrolled 388 antiretroviral therapy (ART) -naïve human immunodeficiency virus (HIV)- infected and 461 healthy adults to determine the association between serum sST2 levels and HIV-associated myocardial diastolic dysfunction, a known precursor of HFpEF [ 24 ]. The study revealed that HIV-infected adults had a higher prevalence of diastolic dysfunction (adjusted odds ratio [OR]: 2.71, 95% CI 1.62–4.55; p < 0.0001), and higher sST2 levels compared to the control group (19.6 vs. 16.1 ng/mL; p = 0.002).…”