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Cardiac Microvascular Dysfunction in Women Living With HIV Is Associated With Cytomegalovirus Immunoglobulin G
Andreas Knudsen1,2,3, Kristina Thorsteinsson1, Thomas E Christensen2,3
1Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark.
Insights
Women living with HIV (WLWH) show significantly lower myocardial flow reserve (MFR) and higher rates of cardiac microvascular dysfunction compared to men. Cytomegalovirus (CMV) IgG is linked to reduced MFR in WLWH, highlighting cardiovascular disease (CVD) risks.
Area of Science:
- Cardiology
- Infectious Diseases
- HIV Research
Background:
- People living with HIV (PLWH) face elevated cardiovascular disease (CVD) risk, potentially greater in women living with HIV (WLWH).
- General population studies show men often have obstructive coronary artery disease (CAD), while women present with nonobstructive patterns and cardiac microvascular dysfunction.
- Investigating cardiac microvascular function in PLWH, particularly sex differences and associations with cytomegalovirus (CMV) immunoglobulin G (IgG), is crucial for understanding CVD risk.
Purpose of the Study:
- To compare cardiac microvascular function, specifically myocardial flow reserve (MFR), between men and women living with HIV (MLWH and WLWH).
- To examine the association between cytomegalovirus immunoglobulin G (CMV IgG) and MFR in MLWH and WLWH.
- To identify potential sex-specific differences in CVD risk factors and mechanisms among people living with HIV (PLWH).
Main Methods:
- A cross-sectional study involving 94 people living with HIV (PLWH) on antiretroviral therapy.
- Myocardial flow reserve (MFR) was quantified using 82Rb positron emission tomography/computed tomography (PET/CT) at rest and during stress.
- Plasma levels of cytomegalovirus (CMV) immunoglobulin G (IgG) were measured.
Main Results:
- Women living with HIV (WLWH) exhibited significantly lower MFR compared to men living with HIV (MLWH) (P = .003).
- >45% of WLWH displayed MFR indicative of cardiac microvascular dysfunction, versus 24% of MLWH (P = .03).
- CMV IgG concentrations were inversely associated with MFR in WLWH, but not in MLWH (P = .05 for interaction).
Conclusions:
- This study reveals significantly lower MFR in WLWH compared to MLWH, with a high prevalence of cardiac microvascular dysfunction in women despite younger age and lower cardiovascular risk.
- An inverse association between CMV IgG and MFR was observed specifically in WLWH, suggesting a potential role for CMV in HIV-related cardiac complications in women.
- These findings underscore the need for heightened awareness and targeted strategies for cardiovascular disease (CVD) prevention in WLWH, irrespective of traditional cardiovascular risk factors.
Background:
People living with HIV (PLWH) appear to be at increased risk of cardiovascular disease (CVD), and this is possibly more pronounced in women living with HIV (WLWH). In the general population, men are more likely to develop obstructive coronary artery disease (CAD), and women often present with a nonobstructive pattern with cardiac microvascular dysfunction. We investigated cardiac microvascular function in men and women living with HIV and tested for association with cytomegalovirus (CMV) immunoglobulin G (IgG), as this has been associated with CVD in PLWH.
Methods:
In a cross-sectional study, 94 PLWH on antiretroviral therapy were scanned with 82Rb positron emission tomography/computed tomography at rest and during adenosine-induced stress, which enables the quantification of the myocardial flow reserve (MFR). CMV IgG was measured in plasma.
Results:
WLWH had significantly lower MFR compared with men living with HIV (MLWH; P = .003), and >45% of the women had an MFR indicative of cardiac microvascular dysfunction, whereas this was only true for 24% of men (P = .03). CMV IgG concentrations were inversely associated with MFR among WLWH but not MLWH (P = .05 for interaction).
Conclusions:
In this first study comparing MFR in women and men living with HIV, we found that WLWH had significantly lower MFR than MLWH and 45% of the women had cardiac microvascular dysfunction despite younger age and lower cardiovascular risk. Furthermore, CMV IgG was inversely associated with MFR among women but not men. This calls for attention to CVD among young WLWH even with low cardiovascular risk.
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