SUBCLINICAL CARDIOVASCULAR DISEASE IN PEOPLE LIVING WITH HIV

Therapeutic Area

ASCVD/CVD Risk Factors

Background

People living with HIV (PLHIV) experience chronic inflammation, which may contribute to tissue fibrosis, premature vascular aging (PVA), and cardiac dysfunction. This cross-sectional pilot study aimed to determine the association of HIV status with cardiorespiratory fitness, inflammation, fibrosis, PVA, and cardiac dysfunction.

Methods

Male veterans, 21 HIV+ and 20 HIV-, were recruited from the Providence VA Medical Center and matched on age (within 5 years), sex, race, and other factors. Participants completed questionnaires, blood tests, a treadmill stress test, echocardiogram, coronary CT scan, and an optional cardiac MRI (CMR). Multivariable linear regressions adjusted for age and smoking status were performed on these data to determine their associations with HIV status.

Results

HIV+ participant age (54.2 ± 11.6 years) was comparable to controls (56.2 ± 11.3 years, p = 0.6), with a similar racial distribution in both groups. HIV status was associated with GDF15, a marker of fibrosis (beta = 109.9, 95% CI [10.6, 209.2], p = 0.031), but not with LogST2, Galectin3 (other markers of fibrosis), Log IL6, or Log CRP (markers of inflammation). HIV+ participants had a higher mean extracellular volume (ECV; a measure of fibrosis on CMR) compared to controls (21.6% vs. 17.9%) and a higher predicted vascular age based on coronary calcium score than controls (55.5 vs. 52.6 years) though neither was statistically significant (p = 0.071, p = 0.645). There was a trend toward a positive association between HIV status and mean ECV (beta = 3.83, 95% CI [-0.30, 8.0], p = 0.067). HIV+ participants had comparable exercise tolerance to controls (11.7 Mets vs 10.4 Mets, p = 0.215). HIV status was negatively associated with right ventricular ejection fraction on CMR (51.8% HIV+ vs. 57.5% Controls, beta= -5.78, 95% CI [-10.8, -0.7], p = 0.027), but not with left ventricular ejection fraction.

Conclusions

Data from this pilot study suggest that HIV+ status is associated with increased myocardial fibrosis and decreased right ventricular function. Further studies are needed to elucidate these findings.