Background:  The mechanism by which HIV infection increases cardiac events remains unclear. The purpose of this study was to determine the prevalence of systolic and diastolic dysfunction in a contemporary group of asymptomatic HIV patients.
Methods:  We performed echocardiography in 196 HIV-infected adults and 52 uninfected controls. Left ventricular (LV) ejection fraction (EF), left ventricular mass indexed to the body surface area, and diastolic function were assessed according to the American Society of Echocardiography standards.
Results:  The average age was 47±8 years and 85% were male. Of the HIV patients, 26% had hypertension, 35% were cigarette smokers, and 38% used intravenous drugs. The median duration of HIV infection was 15 years (IQR 11 to 18), 82% were on ART, and 63% had an undetectable viral load. As shown in the table, LV mass index was higher in HIV patients, EF was similar in both groups, and 9 (4.6%) of the HIV patients had evidence of LV systolic dysfunction (defined as an EF <50%); 49% of HIV patients had diastolic dysfunction (vs 29%, p = 0.008); 98 HIV patients had stage I diastolic dysfunction while 2 had stage II diastolic dysfunction. After controlling for diabetes mellitus, intravenous drug use, and prior coronary artery disease, HIV-infection was independently associated with 2.48 higher odds of diastolic dysfunction (95%CI 1.17 to 5.25, p = 0.017) along with age, hypertension, and EF. Duration of protease inhibitor therapy, CD4 count, and HIV viral load were not associated with diastolic dysfunction.
Conclusions:  Asymptomatic HIV-infected patients had a higher prevalence of cardiac abnormalities (higher LV mass and diastolic dysfunction) compared to controls. HIV infection was independently associated with diastolic dysfunction. Diastolic dysfunction in HIV patients was only partly related to age, hypertension, and decreased EF. Future studies are needed to ascertain the etiology and natural history of diastolic dysfunction in HIV-infected patients.