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Diastolic Dysfunction in Patients With Human Immunodeficiency Virus Receiving Antiretroviral Therapy: Results From
Javed Butler1, Stephen J Greene2, Svati H Shah3
1Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi.
Insights
Diastolic dysfunction in HIV+ individuals is linked to heart muscle fibrosis and left atrial issues, impacting quality of life. Further research is needed to explore therapeutic targets for managing cardiac changes in HIV patients.
Area of Science:
- Cardiology
- Infectious Diseases
- Biomedical Research
Background:
- Diastolic dysfunction (DD) is prevalent and occurs earlier in human immunodeficiency virus-infected (HIV+) individuals.
- The underlying mechanisms and clinical consequences of DD in HIV+ individuals remain poorly understood.
Purpose of the Study:
- To investigate the cardiac structural and functional alterations associated with diastolic dysfunction in a contemporary cohort of HIV+ individuals on antiretroviral therapy.
- To identify biomarkers and clinical factors linked to DD in this population.
Main Methods:
- A multicenter, cross-sectional case-control study (Characterization of Heart Function on Antiretroviral Therapy - CHART) compared HIV+ individuals with (DD+) and without (DD-) diastolic dysfunction.
- Participants had normal ejection fraction and no significant comorbidities affecting cardiac function.
- Cardiac structure, function, fibrosis, and relevant biomarkers were assessed using echocardiography, cardiac magnetic resonance, and laboratory tests.
Main Results:
- Diastolic dysfunction patients were older, with higher BMI, hypertension, renal dysfunction, and dyslipidemia.
- Elevated N-terminal pro-B-type natriuretic peptide and high-sensitivity troponin I levels were observed in DD+ patients.
- Increased left atrial stiffness, higher prevalence of focal myocardial fibrosis, and elevated markers of collagen turnover were found in DD+ individuals.
- DD+ patients reported worse quality of life, specifically in physical limitations and symptom frequency.
Conclusions:
- In treated HIV+ individuals, diastolic dysfunction is associated with significant cardiac structural and functional abnormalities, including myocardial fibrosis and left atrial dysfunction.
- These findings highlight the complex interplay between HIV, antiretroviral therapy, and cardiac health.
- Further longitudinal studies are warranted to evaluate therapeutic targets for preventing cardiac remodeling and dysfunction in HIV.
Background:
Diastolic dysfunction (DD) is common and occurs at an earlier age among human immunodeficiency virus-infected (HIV+) individuals, but the mechanisms and consequences of DD among HIV+ individuals are unclear.
Methods And Results:
The Characterization of Heart Function on Antiretroviral Therapy (CHART) study was a multicenter cross-sectional case-control study of treated and virally suppressed HIV+ individuals with (DD+) and without DD (DD-). All patients had normal ejection fraction (>50%), no significant valvular disease, and no history of coronary revascularization or persistent atrial fibrillation. Overall, 94 DD+ and 101 DD- patients were included. DD+ patients were older with higher body mass index (BMI) and more likely to have hypertension, renal dysfunction, and dyslipidemia. Groups were similar with respect to sex, race, CD4 count, and HIV RNA copies. N-terminal pro-B-type natriuretic peptide levels (median 36 [23, 85] vs 26 [12, 49] pg/mL, P < .01) and high-sensitivity troponin I (3.6 [2.6, 5.1] vs 2.5 [1.8, 3.5] pg/mL, P < .01) were higher among DD+ patients. The latter had similar left atrial size, but increased stiffness (conduit strain: 23.5 [17.5, 36.9] vs 30.0 [22.9, 37.0], P < .01) and impaired relaxation (reservoir strain: 39.7 [32.0, 58.0] vs 45.9 [37.0, 60.6], P = .04). On cardiac magnetic resonance, the prevalence of focal fibrosis was higher among DD+ patients (19.0% vs 5.3%, P < .01). DD+ patients demonstrated higher levels of carboxyl-terminal telopeptide of collagen type I (P = .04), and trends toward higher interleukin-6 and oxidized low-density lipoprotein levels (P ≤ .08). Kansas City Cardiomyopathy Questionnaire physical limitation (87.1±21.4 vs 93.1±18.1, P = .01) and symptom frequency scores were lower among DD+ patients (86.0±21.5 vs 92.5±16.8, P = .01).
Conclusions:
In this contemporary HIV+ population receiving antiretroviral therapy, DD was associated with multiple alterations in cardiac structure and function, including myocardial fibrosis and left atrial abnormalities, and worse quality of life. Further studies are needed to assess longitudinal changes in these parameters and their potential as therapeutic targets to prevent progressive cardiac remodeling and dysfunction in HIV.
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