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Cardiac Dysfunction in People Living With HIV
Study Questions:
What is the frequency and relative risk of clinical heart failure (HF)—(left ventricular systolic dysfunction [LVSD], left ventricular diastolic dysfunction [DD], right ventricular systolic dysfunction [RVSD]), dilated cardiomyopathy (DCM), or pulmonary hypertension (PH)—among people living with human immunodeficiency virus (HIV)?
Methods:
The study authors searched electronic databases and reference lists of review articles and combined the study-specific estimates using random-effects model meta-analyses of DerSimonian-Laird method. Exclusion criteria were study size <50, studies including children <15 years of age, studies of HIV patients in which participants were selected based on suspected or known cardiac disease, and reports based on autopsy examination to diagnose heart disease. They explored sources of heterogeneity using subgroup analyses and/or meta-regression by the following a priori–defined study-level characteristics: publication year, study region, study quality, study size, average age, proportion males, proportion with acquired immune deficiency syndrome (AIDS), average CD4 T-cell count, and proportion on antiretroviral therapy. They assessed between-study heterogeneity using Q and I2 statistics.
Results:
This article included 63 reports from 54 studies comprising up to 125,382 adults with HIV infection and 12,655 cases of various cardiac dysfunctions. The pooled prevalence (95% confidence interval) was 12.3% (6.4-19.7%; 26 studies) for LVSD; 12.0% (7.6-17.2%; 17 studies) for DCM; 29.3% (22.6-36.5%; 20 studies) for grades I-III diastolic dysfunction; and 11.7% (8.5-15.3%; 11 studies) for grades II-III diastolic dysfunction. The authors found that the pooled incidence and prevalence of clinical HF were 0.9 per 100 person-years (0.4-2.1 per 100 person-years; 4 studies) and 6.5% (4.4-9.6%; 8 studies), respectively. The combined prevalence of PH and RVSD were 11.5% (5.5-19.2%; 14 studies) and 8.0% (5.2-11.2%; 10 studies), respectively. They observed significant heterogeneity across studies for all the outcomes analyzed (I2 > 70%, p < 0.01), only partly explained by available study-level characteristics. There was a trend for lower prevalence of LVSD in studies reporting higher antiretroviral therapy use or lower proportion of AIDS. The prevalence of LVSD was higher in the African region. After taking into account the effect of regional variation, there was evidence of lower prevalence of LVSD in studies published more recently. The frequency of cardiomyopathy in people living with HIV reported in this review is significantly higher than that reported by studies of general populations, which is in the range of 4-6%. Similarly, the prevalence of DD is 1.5- to 2-fold higher when compared with those reported for individuals in general populations.
Conclusions:
The authors concluded that cardiac dysfunction is frequent in people living with HIV.
Perspective:
This is an important study because it shines a light on the burden of cardiac dysfunction in patients with HIV. Although triple retroviral therapy has somewhat ameliorated the natural history of cardiac dysfunction, this study suggests that there is a significant opportunity to detect and treat underlying cardiomyopathy.
Clinical Topics: Cardiovascular Care Team, Diabetes and Cardiometabolic Disease, Heart Failure and Cardiomyopathies, Prevention, Pulmonary Hypertension and Venous Thromboembolism, Vascular Medicine, Acute Heart Failure, Pulmonary Hypertension, Hypertension
Keywords: Acquired Immunodeficiency Syndrome, Autopsy, Cardiomyopathies, Cardiomyopathy, Dilated, Heart Failure, HIV Infections, Hypertension, Pulmonary, Lymphocyte Count, Risk Assessment, Ventricular Dysfunction, Left, Ventricular Dysfunction, Right
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