HIV and Cardiac End-Organ Damage in Women: Findings from an Echocardiographic Study Across the United States.

BACKGROUND: People with HIV have been reported to have increased risk of clinical and subclinical cardiovascular disease. Existing studies have focused on men and often have been uncontrolled or lacked adequate HIV-negative comparators.

METHODS: We performed echocardiography in participants with, or at risk for, HIV from the Women's Interagency HIV Study. We evaluated associations of HIV and HIV-related factors with cardiac phenotypes, including left ventricular systolic dysfunction (LVSD), isolated LV diastolic dysfunction (LVDD), left atrial enlargement (LAE), LV hypertrophy (LVH), and increased tricuspid regurgitation velocity (TRV).

RESULTS: Of 1654 participants (age 51 ± 9), 70% were HIV-positive. Sixty-three (5.4%) women with HIV (WWH) had LVSD; 71 (6.5%) had isolated LVDD. Compared to women without HIV (WWOH), WWH had a near-significantly increased risk of LVSD (adjusted RR = 1.69 [95% CI = 1.00, 2.86], p = 0.051). No significant association was noted for HIV seropositivity with other phenotypes, but there was a risk gradient for decreasing CD4 + count among WWH that approached or reached significance for isolated LVDD (ptrend = 0.069), LAE (ptrend = 0.002) and LVH (ptrend = 0.003). WWH with CD4 + count < 200 cells/mm3 had significantly higher prevalence of LAE, LVH and high TRV than WWOH (p < 0.05). There were no consistent associations for viral suppression or antiretroviral-drug exposure.

CONCLUSIONS: This study suggests that WWH have a higher risk of LVSD compared to sociodemographically smilar WWOH, but their risk for isolated LVDD, LAE, LVH, and high TRV is increased only with reduced CD4 + count. Although these findings warrant replication, they support the importance of cardiovascular risk-factor and HIV-disease control for heart disease prevention in this population.