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Prevalence and Risk Factors in HIV-infected Persons for Echocardiographic Abnormalities in the Era of Modern HAART
K Mondy1, J Gottdiener2, Turner Overton*1, K Henry3, L Conley4, T Bush4, J Hammer5, C Carpenter6, M Kojic6, J Brooks4, and SUN Study Investigators
1Washington Univ Sch of Med, St Louis, MO, US; 2Univ of Maryland, Baltimore, US; 3HIV Prgm, Hennepin County Med Ctr, Univ of Minnesota, MN, US; 4CDC, Atlanta, GA, US; 5Univ of Colorado Hlth Sci Ctr, Denver, US; and 6Miriam Hosp, Providence, RI, US
Background: Cardiac function among HIV-infected
persons in the contemporary treatment era has not been well characterized.
Methods: The SUN Study is a prospective cohort of
682 HIV-infected patients receiving care at clinics in Denver, Minneapolis, Providence, and St. Louis. At baseline, all patients underwent standardized
echocardiographic examination. Using multivariate logistic regression modeling,
we identified independent predictors of left ventricular systolic dysfunction
(LVSD = ejection fraction <55%), diastolic dysfunction (DD), pulmonary
hypertension (right ventricular systolic pressure >30 mmHg), and LV hypertrophy (LVH = LV mass >45 [women] and >49 [men] g/m2).
Results: Characteristics for 667 subjects with
available data were: median age 41 years, 23% women, 27% black, median body
mass index 25.4 kg/m2, 79% on HAART, median CD4 cell count 458
cell/µL, 59% with HIV viral load <400 copies/mL, 13% hypertensive, 6%
diabetic, 44% smokers. Of 663 evaluable subjects, 18% had LVSD (111 [17.6%]
mild, 3 [<1%] moderate, 0 severe); 23% of 660 evaluable subjects had DD (139
[21.1%] grade 1 [G1], 14 [2.1%] G2, 0 G3); 23% of 326 evaluable patients (i.e.,
had any tricuspid regurgitant flow present) had pulmonary hypertension (53
[16.3%] mild, 17 [5.2%] moderate, 5 [1.5%] severe), 6.6% of 604 evaluable
subjects had LVH (24 [4.0%] mild, 8 [1.3%] each moderate and severe).
Multivariate analyses demonstrated the following independent associations: for
LVSD—male sex (odds ratio [OR] 2.0, p = 0.014), carotid intima-media
thickness ([IMT] OR 1.6 if >1.7 mm [median value], p = 0.026), and
smoking (OR 1.5, p = 0.043); for DD—LDL cholesterol (OR 1.9 if >83
mg/dL [first quartile], p = 0.033), history of opportunistic infection
(OR 0.5, p = 0.024), use of inhaled nitrites (OR 0.4, p = 0.024);
for pulmonary hypertension—visceral fat volume (OR 2.5 if >162 cm2
[fourth quartile] p = 0.002); and for LVH—body mass index (OR 3.6 if ≥22
[first quartile], p <0.001), IMT (OR 1.2 if >1.7 mm [median
value], p = 0.010), and use of marijuana (OR 2.2, p <0.001)
and heroin (OR 1.9, p = 0.040).
Conclusions: In this cohort of contemporary
HAART-era patients, subclinical abnormalities in cardiac function were detected
frequently. Functional abnormalities were mostly associated with expected and
often modifiable risks, and notably not antiretrovirals. Our analysis suggests
lifestyle modification should become a greater priority in the management of
chronic HIV disease.
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