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Right and left cardiac function in HIV-infected patients investigated using radionuclide ventriculography and brain
U S Kristoffersen1, A M Lebech, J Gerstoft
1Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, Copenhagen, Denmark. ulriksk@mfi.ku.dk
Insights
Myocardial dysfunction is not a significant issue in well-treated HIV patients. Modern antiretroviral therapy appears to have resolved HIV-related cardiomyopathy, with no new cases observed.
Area of Science:
- Cardiology
- Infectious Diseases
- Public Health
Background:
- HIV infection historically associated with cardiomyopathy.
- Advancements in highly active antiretroviral therapy (HAART) have improved immunocompetency and viral load in HIV patients.
- Potential for HAART to cause cardiomyopathy remains a concern.
Purpose of the Study:
- To assess the incidence of myocardial dysfunction in HIV-infected individuals on contemporary treatment.
- To evaluate changes in cardiac function over time in this population.
Main Methods:
- Prospective study involving 91 HIV patients.
- Radionuclide ventriculography to measure left ventricular ejection fraction (LVEF) and right ventricular ejection fraction (RVEF).
- Brain natriuretic peptide (BNP) levels measured; follow-up conducted on 63 patients after a mean of 4.5 years.
Main Results:
- All patients maintained normal LVEF throughout the study.
- A small, statistically significant increase in mean LVEF was observed at follow-up.
- Reduced RVEF was infrequent (6% initially, 3% at follow-up) and not significantly changed.
- No patients exhibited elevated BNP levels or significant changes in mean BNP.
Conclusions:
- HIV-related cardiomyopathy is not a significant clinical problem in closely monitored, well-treated HIV-infected patients.
- Improved immune status and viral control due to HAART likely mitigate the risk of HIV-related cardiomyopathy.
- No evidence suggests that HAART itself causes cardiomyopathy in this cohort.
Objective:
The aim of the study was to determine the incidence of myocardial dysfunction in an HIV-infected population receiving state-of-the-art treatment.
Methods:
Between April 2001 and July 2002, 91 HIV-infected patients had a radionuclide ventriculography performed with determination of right ventricular ejection fraction (RVEF) and left ventricular ejection fraction (LVEF), as well as measurement of brain natriuretic peptide (BNP). Between July 2005 and January 2007, 63 patients (69%) agreed to participate in a follow-up study with a mean follow-up of 4.5 years.
Results:
All patients had normal LVEF at both examinations. A minimal increase in mean LVEF of 0.02 was observed at follow-up (P=0.01). At the initial visit, four patients [6%; 95% confidence interval (CI) 2-15%] had a reduced RVEF, and at follow-up two patients (3%; 95% CI 0-11%) had slightly reduced RVEF. No significant change in mean RVEF was found. No patients had increased BNP and no change in mean plasma BNP was found.
Conclusions:
HIV-related cardiomyopathy appears not to constitute a problem in closely monitored, well-treated HIV-infected patients. Compared with pre-highly active antiretroviral therapy (HAART) studies, it seems that the improvement in immunocompetency and viral load has removed the problem of HIV-related cardiomyopathy. Although HAART has been suggested as a possible new cause of cardiomyopathy, we did not find any evidence of this.
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