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Cardiac Dysfunction Among People Living With HIV: A Systematic Review and Meta-Analysis
Sebhat Erqou1, Bereket Tessema Lodebo2, Ahmad Masri3
1Department of Medicine, Providence VA Medical Center, Providence, Rhode Island; Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island.
Insights
Cardiac dysfunction is common in people with human immunodeficiency virus (HIV). This meta-analysis found varying prevalence rates for conditions like left ventricular systolic dysfunction and heart failure, highlighting the need for further research.
Area of Science:
- Cardiology
- Infectious Diseases
- Epidemiology
Background:
- Cardiac dysfunction is a significant concern in individuals with human immunodeficiency virus (HIV).
- Existing epidemiological data on the prevalence and risk factors of HIV-associated cardiac dysfunction require comprehensive synthesis.
- This study addresses the need for a synthesized understanding of cardiac dysfunction burden in people living with HIV.
Purpose of the Study:
- To systematically synthesize and meta-analyze existing epidemiological data on the frequency of various cardiac dysfunctions in people living with HIV.
- To quantify the pooled prevalence and incidence of specific cardiac conditions, including left ventricular systolic dysfunction, dilated cardiomyopathy, diastolic dysfunction, heart failure, pulmonary hypertension, and right ventricular dysfunction.
- To explore heterogeneity and identify potential factors influencing the prevalence of cardiac dysfunction in this population.
Main Methods:
- A systematic literature search was conducted across electronic databases and reference lists of review articles.
- Random-effects model meta-analyses were employed to combine study-specific prevalence and incidence estimates.
- Subgroup analyses and meta-regressions were utilized to investigate heterogeneity across studies.
Main Results:
- The meta-analysis included 63 reports from 54 studies, encompassing up to 125,382 adults with HIV.
- Pooled prevalence estimates included: left ventricular systolic dysfunction (12.3%), dilated cardiomyopathy (12.0%), grades I-III diastolic dysfunction (29.3%), and grades II-III diastolic dysfunction (11.7%).
- Prevalence of pulmonary hypertension was 11.5%, right ventricular dysfunction was 8.0%, and clinical heart failure was 6.5%. Significant heterogeneity was observed, with trends suggesting lower left ventricular systolic dysfunction prevalence with higher antiretroviral therapy use and more recent publication dates.
Conclusions:
- Cardiac dysfunction is a frequent complication in people living with HIV.
- Significant heterogeneity exists in reported prevalence rates, partly explained by regional variations and treatment factors.
- Further prospective studies are crucial to elucidate the mechanisms and comprehensively understand the burden and risk of HIV-related cardiac dysfunction.
Objective:
To synthesize existing epidemiological data on cardiac dysfunction in HIV.
Background:
Data on the burden and risk of human immunodeficiency virus (HIV) infection-associated cardiac dysfunction have not been adequately synthesized. We performed meta-analyses of extant literature on the frequency of several subtypes of cardiac dysfunction among people living with HIV.
Methods:
We searched electronic databases and reference lists of review articles and combined the study-specific estimates using random-effects model meta-analyses. Heterogeneity was explored using subgroup analyses and meta-regressions.
Results:
We included 63 reports from 54 studies comprising up to 125,382 adults with HIV infection and 12,655 cases of various cardiac dysfunctions. The pooled prevalence (95% confidence interval) was 12.3% (6.4% to 19.7%; 26 studies) for left ventricular systolic dysfunction (LVSD); 12.0% (7.6% to 17.2%; 17 studies) for dilated cardiomyopathy; 29.3% (22.6% to 36.5%; 20 studies) for grades I to III diastolic dysfunction; and 11.7% (8.5% to 15.3%; 11 studies) for grades II to III diastolic dysfunction. The pooled incidence and prevalence of clinical heart failure were 0.9 per 100 person-years (0.4 to 2.1 per 100 person-years; 4 studies) and 6.5% (4.4% to 9.6%; 8 studies), respectively. The combined prevalence of pulmonary hypertension and right ventricular dysfunction were 11.5% (5.5% to 19.2%; 14 studies) and 8.0% (5.2% to 11.2%; 10 studies), respectively. Significant heterogeneity was observed across studies for all the outcomes analyzed (I2 > 70%, p < 0.01), only partly explained by available study level characteristics. There was a trend for lower prevalence of LVSD in studies reporting higher antiretroviral therapy use or lower proportion of acquired immune deficiency syndrome. The prevalence of LVSD was higher in the African region. After taking into account the effect of regional variation, there was evidence of lower prevalence of LVSD in studies published more recently.
Conclusions:
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. (Cardiac dysfunction in people living with HIV-a systematic review and meta-analysis; CRD42018095374).
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