HIV, HIV-Specific Factors, and Myocardial Disease in Women

Author:

Kato Yoko1ORCID,Ambale-Venkatesh Bharath2,Naveed Mahim34,Shitole Sanyog G345,Peng Qi6,Levsky Jeffrey M6,Haramati Linda B7,Ordovas Karen8,Noworolski Susan M9,Lee Yoo Jin9,Kim Ryung S10,Lazar Jason M11,Anastos Kathryn5,Tien Phyllis C12,Kaplan Robert C1013,Lima Joao A C1,Kizer Jorge R3414ORCID

Affiliation:

1. Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine , Baltimore, Maryland , USA

2. Department of Radiology, Johns Hopkins School of Medicine , Baltimore, Maryland , USA

3. Cardiology Section, San Francisco Veterans Affairs Health Care System , San Francisco, California , USA

4. Department of Medicine, University of California, San Francisco , San Francisco, California , USA

5. Department of Medicine, Montefiore Health System and Albert Einstein College of Medicine , Bronx, New York , USA

6. Department of Radiology, Montefiore Health System and Albert Einstein College of Medicine , Bronx, New York , USA

7. Department of Radiology and Biomedical Imaging, Yale School of Medicine , New Haven, Connecticut , USA

8. Department of Radiology, University of Washington , Seattle, Washington , USA

9. Department of Radiology and Biomedical Imaging, University of California , San Francisco, California , USA

10. Department of Epidemiology and Population Health, Albert Einstein College of Medicine , Bronx, New York , USA

11. Division of Cardiology, Department of Medicine, State University of New York Downstate Health Sciences University , Brooklyn, New York , USA

12. Section of Infectious Diseases, San Francisco Veterans Affairs Health Care System, and Department of Medicine, University of California, San Francisco , San Francisco, California , USA

13. Public Health Sciences Division, Fred Hutchinson Cancer Center , Seattle, Washington , USA

14. Department of Epidemiology and Biostatistics, University of California , San Francisco, California , USA

Abstract

Abstract Background People with human immunodeficiency virus (HIV) (PWH) have an increased risk of cardiovascular disease (CVD). Cardiac magnetic resonance (CMR) has documented higher myocardial fibrosis, inflammation, and steatosis in PWH, but studies have mostly relied on healthy volunteers as comparators and focused on men. Methods We investigated the associations of HIV and HIV-specific factors with CMR phenotypes in female participants enrolled in the Women's Interagency HIV Study's New York and San Francisco sites. Primary phenotypes included myocardial native (n) T1 (fibro-inflammation), extracellular volume fraction (fibrosis), and triglyceride content (steatosis). Associations were evaluated with multivariable linear regression, and results pooled or meta-analyzed across centers. Results Among 261 women with HIV (WWH, N = 362), 76.2% had undetectable viremia at CMR. For the 82.8% receiving continuous antiretroviral therapy (ART) in the preceding 5 years, adherence was 51.7%, and 69.4% failed to achieve persistent viral suppression (40.7% with peak viral load <200 cp/mL). Overall, WWH showed higher nT1 than women without HIV after full adjustment. This higher nT1 was more pronounced in those with antecedent or current viremia or nadir CD4+ count <200 cells/μL, with the latter also associated with higher extracellular volume fraction. WWH and current CD4+ count <200 cells/μL had less cardiomyocyte steatosis. Cumulative exposure to specific ART showed no associations. Conclusions Compared with sociodemographically similar women without HIV, WWH on ART exhibit higher myocardial fibro-inflammation, which is more prominent with unsuppressed viremia or CD4+ lymphopenia. These findings support the importance of improved ART adherence strategies, along with better understanding of latent infection, to mitigate cardiac end-organ damage in this population.

Funder

National Institutes of Health

Publisher

Oxford University Press (OUP)

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