Patients with HIV frequently have cardiac dysfunction, according to a study recently published in JACC Heart Failure.
This study included results from 125,382 individuals with HIV whose data was obtained from 12,655 cardiac dysfunction cases across 54 studies. Electronic databases and reference lists were used to compile studies on adults with HIV, which were pooled based on a consistent definition of cardiac dysfunction. The hypothesis that the incidence of left ventricular systolic dysfunction has decreased following the advent of antiretroviral therapy was tested. Small-study bias was examined with the Egger regression tests for funnel-plot asymmetry. Small and large studies were grouped by participant number and compared using meta-regressions and subgroup analyses to assess publication bias and heterogeneity.
Left ventricular systolic dysfunction had a pooled prevalence of 12.3% (95% CI, 6.4%-19.7%; 26 studies), dilated cardiomyopathy of 12.0% (95% CI, 7.8%-17.2%; 17 studies), diastolic dysfunction grades I to III of 29.3% (95% CI, 22.6-36.5%; 20 studies), and diastolic dysfunction grades II to III of 11.7% (95% CI, 8.5%-15.3%). Heart failure had a prevalence of 6.5% (95% CI, 4.4%-9.6%; 8 studies) and an incidence of 0.9 per 100 person-years (95% CI, 0.4-2.1 per 100 person-years; 4 studies). Pulmonary hypertension had a pooled prevalence of 11.5% (95% CI, 5.5%-19.2%; 14 studies), and right ventricular dysfunction of 8.0% (95% CI, 5.2%-11.2%; 10 studies). Studies were heterogeneous for all outcomes (I2>70%; P <.01). Left ventricular systolic dysfunction was noted to be higher in Africa and was rarer in studies with lower rates of AIDS or greater antiretroviral therapy use. There was a significant decrease in left ventricular systolic dysfunction in more recent studies (P =.03), though its prevalence increased with risk of bias and greater proportions of young study participants (P =.01). However, researchers found no difference between subgroups of studies published before and after the era of antiretroviral therapy.
Limitations to this study included limited data quality in assessed studies, a changed definition of diastolic dysfunction from that used by some older studies, limited generalizability as a result of significant heterogeneity, and publication bias for certain outcomes.
The study authors concluded that “[cardiac] dysfunction is frequent in people living with HIV. Additional prospective studies are needed to better understand the burden and risk of various forms of cardiac dysfunction related to HIV and the associated mechanisms.”
Erqou S, Lodebo BT, Masri A, et al. Cardiac dysfunction among people living with HIV: a systematic review and meta-analysis.JACC: Heart Fail. 2019;7(2):98-108