Characteristic And Mechanism Of Cardiac Structure Or Function Abnormalities Of Chinese People Living With HIV Under Long Term CART

Background and Objectives:After the advent of combined antiretroviral therapy(cART),AIDS related mortality went down dramatically.HIV infection has become a chronic disease that requires lifelong follow-up and treatment.Long term side effects of HIV infection and ART have become the hot spots.Cardiovascular disease(CVD)is a major component of HIV associated non-AIDS conditions(HANA),with high morbidity and mortality.Traditional CVD risk factors,side effects of ART and immune activation or chronic inflammation are all possible contributors.This study aims to investigate the cardiac structure or function abnormalities of Chinese HIV patients who are treated with cART and in viral suppressed state for a long time,and to look for the possible mechanism of the cardiovascular abnormalities.Methods:Fifty-one HIV infected male adults meeting the criteria of long term cART and viral suppression were selected from the patients at Peking Union Medical College Hospital.Transthoracic echocardiography(TTE)and brachial artery flow-mediated dilation(FMD)were performed at enrollment.Clinical information was collected and peripheral blood was taken for the measurement of T lymphocyte subsets,and plasma was stored for inflammatory markers measurement.Twenty-five age-matched healthy male controls were enrolled from community.TTE and FMD were also performed for these controls,while clinical data were collected.Results:1.Fifty-one Chinese HIV infected males under long term cART and viral suppression had an average age of 43.3 ± 10.2 years.Median of global longitudinal strain(GLS)was-17.6(-18.7,-16.0)%,with a prevalence of 23.5%for reduced GLS.Average left ventricular mass index(LVMI)was 85.56 ± 16.00 g/m2,with a prevalence of 21.6%for increased left ventricular mass,and prevalence of 23.5%for left ventricular remodeling.Median of flow-mediated dilation was 9.2(5.1,14.9)%,with a prevalence of 56.9%for reduced FMD.2.For the fifty-one HIV infected males,univariate analysis of HIV and CVD factors on the prevalence of TTE and FMD abnormalities revealed no significant variable.3.Twenty-five of the HIV infected males were compared with age and gender matched healthy controls.There was no difference between traditional CVD risk factors or CVD risk estimation.The Framingham risk score(FRS)measured 10-year CVD risk was 7.9(3.3,11.2)%,which was similar compared with 6.2(3.9,13.2)%for healthy controls(p=0.853).4.Under the circumstance of normal ejection fraction(EF)and no significant difference of EF between HIV infected males and healthy controls,HIV infected males had a lower GLS compared with healthy controls(p=0.051).HIV infected males had significantly higher LVMI compared with normal controls(p<0.001).Prevalence of increased left ventricular mass was higher in HIV infected males compared with normal controls(p=0.027).Prevalence of left ventricular remodeling was higher in HIV infected males(p=0.013).HIV infected males had a lower FMD compared with healthy controls(p<0.001).Prevalence of reduced FMD was higher in HIV infected males compared with normal controls(p<0.001).5.Multivariate logistic regression revealed only HIV infection was significantly associated with left ventricular remodeling(OR=16.00,95%CI:1.86,137.97,p=0.012),increased left ventricular mass(OR=11.29,95%CI:1.29,98.99,p=0.029)and reduced flow-mediated dilation(OR=15.58,95%CI:3.58,67.78,p<0.001).Conclusion:1.Prevalence of subclinical left ventricular dysfunction,left ventricular remodeling or macrovascular endothelial dysfunction was higher in Chinese HIV infected males under long term cART and viral suppression compared with healthy controls.2.Traditional CVD risk factors and CVD risk estimation were similar between HIV infected males and age and gender matched healthy controls.3.HIV infection was significantly associated with left ventricular remodeling,increased left ventricular mass and reduced flow-mediated dilation.