Myocardial fibro-inflammation higher in women with vs without HIV

Women with HIV infection, receiving antiretroviral therapy (ART), particularly those with unsuppressed viremia or lymphopenia, have higher myocardial fibro-inflammation relative to HIV-negative women, according to results of a study published in Clinical Infectious Diseases.

Patients with HIV are at increased risk for cardiovascular disease (CVD). However, because CVD risk factors are more prevalent in this population, the true impact of HIV on myocardial tissue remains unclear.

In this cross-sectional, observational study, researchers examined associations of HIV and HIV-specific factors with cardiac magnetic resonance phenotypes in women. Data for this analysis were sourced from a longitudinal investigation of women with and without HIV infection the United States. Eligible patients (N=362) were evaluated for fibro-inflammation, fibrosis, and steatosis.

Among women with (n=261) and without (n=101) HIV infection included in the final analysis, the median ages were 54 and 52 years (P =.002), 60.2% and 68.3% were Black, the median BMI was 29.2 and 29.4 kg/m², 72.8% and 52.5% were postmenopausal (P <.001), and 4.2% and 10.9% had a history of myocardial infarction (P =.017), respectively.

In HIV-positive women, 23.8% had detectable viremia, 69.4% had unsuppressed viremia within the previous 5 years, 48.3% were nonadherent to ART within the previous 5 years, and 75.1% had a CD4⁺ count of at least 500 cells/µL.

Compared with women without HIV infection, HIV-positive women had lower left ventricular (LV) mass index (median, 43.7 vs 45.3 g/m²; P =.026) but higher raw native T1 (median, 1276 vs 1264 milliseconds; P =.038) and higher phantom-calibrated native T1 (median, 1277 vs 1263 milliseconds; P =.022).

No between-group differences were observed in LV ejection fraction, late gadolinium enhancement (LGE) scar, myocardial extracellular volume fraction (ECV), phantom-calibrated myocardial ECV, or myocardial triglyceride content.

However, the researchers observed positive correlations between myocardial native T1 and myocardial ECV (r, 0.29), LGE scar (r, 0.23), and LV mass index (r, 0.12); between myocardial ECV and LGE scar (r, 0.24) and LV mass index (r, 0.21); and between LV mass index and LGE scar (r, 0.12).

Further analysis showed that myocardial native T1 was significantly associated with HIV status (P =.038), heart rate (P <.001), history of heart failure (P =.017), smoking status (P =.011), annual income (P =.036), and study site (P =.002). Moreover, myocardial ECV was significantly associated with race/ethnicity (P =.038), BMI (P <.001), smoking status (P =.013), heavy alcohol use (P =.042), history of heroin or cocaine use (P =.003), and study site (P =.001).

In a fully adjusted logistic regression model, HIV-related factors significantly associated with myocardial native T1 were as follows:

• Nadir CD4⁺ count in the past 5 years (<200 cells/µL; mean change, 25.1; P =.019);
• Detectable viremia (mean change, 19.8; P =.041);
• High CD4+ count (³500 cells/µL; mean change, 15.4; P =.023);
• HIV seropositivity (mean change, 15.3; P =.020);
• Unsuppressed viremia in the past 5 years (mean change, 14.5; P =.044); and
• Undetectable viremia (mean change, 13.9; P =.041).

Limitations of this study include the cross-sectional, observational design, as well as a potential lack of generalizability to other settings.

According to the researchers, “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.”

Disclosures: Multiple study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

By Jessica Nye, PhD

References:

Kato Y, Ambale-Venkatesh B, Naveed M, et al. HIV, HIV-specific factors and myocardial disease in women. Clin Infect Dis. Published online February 13, 2024. doi:10.1093/cid/ciae077