Arterial Hypotension in Heart Failure Patients Infected With Human Immunodeficiency Virus

Highlights Arterial hypotension is a factor aggravating the course of heart failure in HIV-infected people in 18.3% of cases, more often accompanied by the development of left ventricular hypertrophy. The risk factor for the development of arterial hypotension in persons infected with the human immunodeficiency virus (HIV) and having HF is the concentration of caspase-6 in the blood serum, which probably indicates the intensification of apoptosis processes in cardiomyocytes. The value of the glomerular filtration rate, calculated by the CKD-EPI formula with the inclusion of the level of cystatin C in the blood serum, is associated with the development of arterial hypotension. Abstract Aim. To study the features of arterial hypotension in HIV-infected patients with HF in comparison with patients with normal blood pressure. Methods. The study included 44 patients with arterial hypotension (AHT) and 76 patients with normal blood pressure (BP) with heart failure (HF) and HIV admitted to a multidisciplinary hospital. All patients underwent the same number of examinations conducted personally by the author: echocardiography, noninvasive arteriography, assessment of the severity of HF using the Clinical Status Assessment Scale by V. Yu. Mareeva, six-minute walk test. Additionally, studies such as the determination of the N-terminal fragment of pro-brain natriuretic peptide (NT-proBNP), cystatin C, caspase-6 and lipocaine 2 (NGAl) were conducted in a laboratory. Results. HIV-infected patients with HF are prone to developing AHT in 18.3% of cases. The results of the study indicate the predominance of males with low body mass index and high alcohol consumption in the group of patients with AHT. Moreover, patients with AHT are more likely to have pericardial effusion in front of the anterior wall of the right ventricle greater than 5 mm, anemia, unsuppressed viral load, left ventricular diastolic dysfunction and hypertrophy. At the same time, the level of cystatin C in their blood serum is lower, and the glomerular filtration rate is higher than in patients without AHT. The level of caspase-6 in the blood serum was significantly higher in the group of patients with AHT. Conclusion. HIV-infected patients with HF are prone to developing AHT in 18.3% of cases. The results of the study indicate a significant predominance of patients with LVH in the group of patients with AHT. The concentration of caspase-6 in blood serum equal to 148.35 pg/mL and higher turned out to be a risk factor for the development of AHT in HIV-infected patients with HF, probably indicating an intensification of apoptosis processes in cardiomyocytes. A glomerular filtration rate (GFR) equal to 47.5 mL/min/1.73 m2 and higher, calculated using the CKD-EPI formula with the inclusion of the level of cystatin C in the blood serum, is associated with a high probability of developing AHT. The pattern obtained may indicate both the activation of apoptosis processes against the background of AHT in the cells of the heart muscle, and the preservation of GFR against this background in patients with HF and HIV infection.