Altered cardiac structure and function in newly diagnosed people living with HIV: a prospective cardiovascular magnetic resonance study after the initiation of antiretroviral treatment

医学 射血分数 心包积液 亚临床感染 心脏病学 内科学 心脏磁共振成像 磁共振成像 前瞻性队列研究 病毒载量 心功能曲线 舒张期 心肌病 抗逆转录病毒疗法 心脏磁共振 人类免疫缺陷病毒(HIV) 心力衰竭 血压 放射科 免疫学
作者
Pieter‐Paul S. Robbertse,Anton Doubell,Jan Steyn,Carl Lombard,Mohammed Abdullahi Talle,Philip Herbst
出处
期刊:International Journal of Cardiovascular Imaging [Springer Science+Business Media]
卷期号:39 (1): 169-182 被引量:9
标识
DOI:10.1007/s10554-022-02711-y
摘要

HIV associated cardiomyopathy (HIVAC) is a poorly understood entity that may progress along a continuum. We evaluated a group of persons newly diagnosed with HIV and studied the evolution of cardiac abnormalities after ART initiation. We recruited a group of newly diagnosed, ART naïve persons with HIV and a healthy, HIV uninfected group. Participants underwent comprehensive cardiovascular evaluation, including cardiovascular magnetic resonance imaging. The HIV group was started on ART and re-evaluated 9 months later. The cardiovascular parameters of the study groups were compared at diagnosis and after 9 months. The ART naïve group's (n = 66) left- and right end diastolic volume indexed for height were larger compared with controls (n = 22) (p < 0.03). The left ventricular mass indexed for height was larger in the naïve group compared with controls (p = 0.04). The ART naïve group had decreased left- and right ventricular ejection fraction (p < 0.03) and negative, non-linear associations with high HIV viral load (p = 0.02). The left ventricular size increased after 9 months (p = 0.04), while the systolic function remained unchanged. The HIV group had a high rate of non-resolving pericardial effusions. HIV infected persons demonstrate structurally and functionally altered ventricles at diagnosis. High HIV viral load was associated with left- and right ventricular dysfunction. Cardiac parameters and pericardial effusion prevalence did not show improvement with ART. Conversely, a concerning trend of increase was observed with left ventricular size. These subclinical cardiac abnormalities may represent a stage on the continuum of HIVAC that can progress to symptomatic disease if the causes are not identified and addressed.
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