Women with HIV have increased risk for left ventricular systolic dysfunction
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Women with HIV have a higher risk for several cardiac conditions, demonstrating the importance of cardiovascular risk factor management and HIV infection control, researchers said.
“Previous studies of people with HIV in the antiretroviral era reported an increased HIV-related risk of cardiac dysfunction, heart failure and dysrhythmias. But such investigations, and particularly imaging studies, were often uncontrolled or included as comparators HIV-negative individuals lacking the behavioral and clinical cardiovascular risk factors known to be overrepresented in people with HIV,” Jorge R. Kizer, MD, MSca, chief of the division of cardiology of the San Francisco Veterans Affairs Health Care System, told Healio. “This raised questions about the extent to which HIV and HIV-specific factors were responsible as opposed to the high prevalence of associated risk factors.”
Source: NIAID.
Kizer added that existing studies focused mostly on men, with data on women, who he said account for nearly 25% of people with HIV in the U.S. and 50% worldwide, being scarce.
To address these gaps, Kizer and colleagues performed standardized echocardiography across the Women's Interagency HIV Study — a study that enrolled women with HIV and sociodemographically similar women without HIV at 10 sites across the U.S. — to investigate the association between HIV and HIV-specific factors and adverse cardiac phenotypes including left ventricular systolic dysfunction (LVSD), isolated LV diastolic dysfunction (LVDD), left atrial enlargement (LAE), LV hypertrophy (LVH) and increased tricuspid regurgitation velocity (TRV).
Of 1,654 participants, 70% were HIV-positive. Among these women, 63 (5.4%) with HIV (WWH) had LVSD, and 71 (6.5%) had isolated LVDD. When compared with women without HIV (WWOH), WWH had a “near-significantly” increased risk of LVSD (aRR = 1.69; 95% CI, 1.00, 2.86).
Additionally, Kizer and colleagues found that no significant association was noted for HIV seropositivity with other phenotypes, but there was a risk gradient for decreasing CD4+ count among WWH that “approached or reached significance” for isolated LVDD (P trend = .069), LAE (P trend = .002) and LVH (P trend = .003). WWH with CD4+ count <200 cells/mm3 had significantly higher prevalence of LAE, LVH and high TRV compared with WWOH (P < .05).
“The present study shows that largely middle-aged women with, or at risk for, HIV in the U.S. have a high frequency of LV systolic dysfunction that appears higher in women with HIV,” Kizer said. “Although additional study is needed to replicate these findings, our results suggest the importance of cardiovascular risk factor management and HIV disease control to prevent cardiovascular morbidity and mortality in this population.”
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