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Left ventricular dysfunction is associated with CD4 lymphocyte count rather than opportunistic infection in human
Wei-Tien Chang1, Chau-Chung Wu, Chien-Ching Hung
1Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Insights
In human immunodeficiency virus (HIV) infection, decreasing CD4 lymphocyte counts are linked to worsening left ventricular (LV) systolic and diastolic dysfunction. Opportunistic infections did not significantly impact LV function in this study.
Area of Science:
- Cardiology
- Infectious Diseases
- Immunology
Background:
- Left ventricular (LV) dysfunction is a common complication in human immunodeficiency virus (HIV) infection, often worsening as the disease progresses.
- CD4 lymphocyte count and opportunistic infections are key indicators for staging HIV infection.
- Understanding the relationship between these indicators and LV dysfunction is crucial for managing HIV patients.
Purpose of the Study:
- To investigate the association between CD4 lymphocyte count and opportunistic infections with left ventricular (LV) dysfunction in HIV-infected individuals.
- To determine the predictive value of CD4 count and opportunistic infections on LV systolic and diastolic function.
Main Methods:
- Echocardiographic evaluation of LV function was performed in 98 HIV-positive patients.
- Patients were categorized based on CD4 lymphocyte count (>or= 200/microL vs. < 200/microL).
- LV function parameters were compared, and in patients with low CD4 counts, function was correlated with opportunistic infections.
Main Results:
- Patients with CD4 counts < 200/microL exhibited significantly lower LV fractional shortening, ejection fraction, and prolonged isovolumic relaxation time compared to those with CD4 counts >or= 200/microL.
- LV systolic and diastolic dysfunctions were positively correlated with decreased CD4 lymphocyte counts.
- No significant differences in LV function were observed between patients with and without opportunistic infections.
Conclusions:
- Left ventricular systolic and diastolic functions deteriorate progressively with decreasing CD4 lymphocyte counts in HIV infection.
- CD4 lymphocyte count is a significant predictor of LV dysfunction in HIV.
- Opportunistic infections appear to play a limited role in the development of LV dysfunction in advanced HIV infection.
Background And Purpose:
Left ventricular (LV) dysfunction is often found in the early stage of human immunodeficiency virus (HIV) infection and deteriorates with disease progression. CD4 lymphocyte count and opportunistic infection are the major indicators for the clinical staging of HIV infection. This study investigated the association of these indicators with LV dysfunction in the clinical course of HIV infection.
Methods:
HIV-positive patients without cardiac manifestations consecutively admitted from May 1998 to April 1999 were enrolled in the study. Echocardiographic LV function evaluation and measurement of CD4 lymphocyte count were performed. Parameters for LV systolic and diastolic functions were compared between patients with CD4 lymphocyte count >or= 200/microL and those with CD4 < 200/microL. In patients with CD4 < 200/microL, LV function was further correlated with the presence or absence of opportunistic infections.
Results:
Ninety eight HIV-positive patients including 52 with CD4 >or= 200/microL and 46 with CD4 < 200/microL were studied. One half of the 46 patients with CD4 < 200/microL had active opportunistic infections. We found that LV fractional shortening, ejection fraction, and isovolumic relaxation time were all significantly lower in the patients with CD4 < 200/microL compared with those with CD4 >or= 200/microL. Moreover, these LV systolic and diastolic dysfunctions were positively correlated with decreased CD4 lymphocyte count. In contrast, no difference was found in these parameters between patients with and without opportunistic infections. In multiple regression analysis, CD4 lymphocyte count was found to be the only factor for predicting the LV systolic and diastolic dysfunction.
Conclusions:
Both LV systolic and diastolic function deteriorate as the CD4 lymphocyte count decreases in HIV infection. Opportunistic infection seems to have a limited role in the pathogenesis of LV dysfunction in advanced HIV infection.