Key result
Among HIV patients on ART with controlled viremia, lack of immune restoration above 500 cells/μL was associated with significantly higher left atrial volume index (33.92 vs 24.91 cm3/m2, p=0.01).
Why the study?
People living with HIV have increased risk of diastolic dysfunction and heart failure with preserved EF, but data on diastolic function and LV changes in those with controlled viremia are limited.
Do people living with HIV on ART with controlled viremia exhibit echocardiographic evidence of diastolic dysfunction or left ventricular hypertrophy?
Observational (n=35)
Do people living with HIV on ART with controlled viremia exhibit echocardiographic evidence of diastolic dysfunction or left ventricular hypertrophy?
Absolute Event Rate: 33.92% vs 24.91%
p-value: p=0.01
In HIV patients with controlled viremia on ART, left atrial enlargement is present in 20% of patients and is associated with worse immune restoration, despite normal systolic function and lack of overt diastolic dysfunction.
Background: People living with human immunodeficiency virus (HIV) (PLWH) have increased risk of developing diastolic dysfunction (DD) and heart failure with preserved ejection fraction (EF). In this observational study, we evaluated DD and left ventricular hypertrophy (LVH) in PLWH receiving antiretroviral therapy (ART) with undetectable viremia. Methods: We conducted an observational study. All participants underwent transthoracic echocardiography to assess chamber size and systolic and diastolic function. Results: Most patients showed concentric remodeling without LVH. All patients had normal left ventricle systolic function (EF median 61.3%, interquartile range: 57.8–66.2). None fulfilled the DD criteria, while two patients (6%) had undetermined diastolic function. Twenty percent (n = 7) of patients had an enlarged left atrium (left atrium volume index [LAVI] > 34 cm3/m2). These patients had a significantly lower CD4+ count (771.53 ± 252.81 vs. 446.00 ± 219.02, p = 0.01) and higher relative wall thickness (0.50 ± 0.05 vs. 0.44 ± 0.06, p = 0.03). Patients without immune restoration above 500 cells/μL had significantly higher LAVI (33.92 ± 6.63 vs. 24.91 ± 7.03, p = 0.01). Conclusions: One-fifth of patients had left atrial enlargement associated with worse immune restoration during ART treatment. The mechanism of left atrial enlargement and its association with cardiovascular risk require further investigations.
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Jachymek et al. (2024) conducted an observational in HIV with controlled viremia (n=35). Lack of immune restoration (>500 cells/μL) vs. Immune restoration (>500 cells/μL) was evaluated on Left atrial volume index (LAVI) (p=0.01). Among HIV patients on ART with controlled viremia, lack of immune restoration above 500 cells/μL was associated with significantly higher left atrial volume index (33.92 vs 24.91 cm3/m2, p=0.01).
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