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Valvular manifestations of human immunodeficiency virus infection--results from the prospective, multicenter
Nico Reinsch1, Stefan Esser, Götz Gelbrich
1aDepartment of Cardiology, West-German Heart Center bDepartment of Dermatology and Venereology, University of Essen, Essen cCenter for Clinical Trials (ZKS), University of Leipzig, Leipzig dDepartment of Dermatology, Ruhr-University Bochum, Bochum, Germany.
Insights
Valvular heart disease is common in HIV patients, with most cases being mild. However, advanced HIV infection stages correlate with a higher prevalence of these cardiac conditions.
Area of Science:
- Cardiology
- Infectious Diseases
- Public Health
Background:
- HIV infection is linked to increased cardiac disease risk.
- Valvular disorders are a significant concern in this population.
Purpose of the Study:
- To determine the prevalence of valvular heart disorders in a large cohort of HIV-infected individuals.
- To explore associations between valvular disorders and HIV disease severity.
Main Methods:
- Prospective, multicenter cohort study of 803 HIV-infected adults.
- Comprehensive two-dimensional transthoracic echocardiography with Doppler evaluation.
- Statistical analysis stratified by HIV infection severity.
Main Results:
- 77.6% of patients exhibited pathological valve function, primarily regurgitation (77.2%).
- Clinically significant valvular disorders were found in 4.7% of patients.
- Higher rates of valvular disease were associated with advanced HIV stages (CDC B/C vs. A).
Conclusions:
- Valvular heart diseases are prevalent in HIV-infected patients.
- Most valvular disorders in this cohort were mild.
- Clinical stage of HIV infection is associated with the development of valvular heart disease.
Background And Aims:
HIV infection is associated with an elevated rate of cardiac diseases. The aim of the current study was to assess the prevalence of valvular disorders in a large population of HIV-infected patients.
Methods:
We enrolled 803 adults (age 44 ± 10 years, 16.6% women) in this prospective, multicenter cohort study. All patients underwent a comprehensive two-dimensional transthoracic echocardiography examination including Doppler evaluation of valvular function. Statistical analyses were performed in respect of severity of HIV infection.
Results:
Overall, the rate of patients with pathologic function of cardiac valves was 77.6% (N = 623). Most of these patients had signs of valvular regurgitation (N = 620; 77.2%), whereas stenoses were rare (N = 23; 2.9%). Clinically relevant valvular disorders (excluding mild stages) were seen in only 4.7% (N = 38; regurgitation: N = 36, 4.5%; stenosis: N = 3, 0.4%). Clinical stages of HIV infection, defined by the Centers for Disease Control and Prevention (CDC) classification, were associated with higher rates of valvular diseases (CDC-stage B/C versus A: 6.2 versus 2.3%, P = 0.015). However, there was no association between current CD4 cell count or virus load and the prevalence of valvular disorders (both P > 0.2). None of the patients had signs of active endocarditis in the present study.
Conclusion:
Valvular heart diseases are common in HIV-infected patients. Fortunately, most of these disorders are mild today. We found an association between the onset of valvular heart disease and clinical stages of HIV infection.
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