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Diastolic dysfunction in people with HIV without known cardiovascular risk factors in Western Kenya

Bethel Woldu1,2,3, Tecla M Temu4, Nicholas Kirui5,6

  • 1Academic Model Providing Access to Healthcare, Eldoret, Kenya bethel.woldu@medstar.net.

Open Heart
|January 22, 2022
PubMed

Insights

Diastolic dysfunction was not prevalent in people living with HIV (PLWH) on antiretroviral therapy (ART) in Kenya. However, PLWH showed increased left ventricular mass and left atrial volume, suggesting subclinical myocardial changes.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Public Health

Background:

  • Diastolic dysfunction (DD) is hypothesized as an early marker of myocardial disease in people living with HIV (PLWH) on antiretroviral therapy (ART).
  • Previous studies suggest a high prevalence of DD in PLWH, but this has not been consistently observed in all populations.
  • Understanding DD prevalence in specific populations, like those in Western Kenya without diabetes or hypertension, is crucial for assessing cardiovascular risk.

Purpose of the Study:

  • To evaluate the prevalence of diastolic dysfunction (DD) in people living with HIV (PLWH) on antiretroviral therapy (ART) in Western Kenya.
  • To compare cardiac structure and function between HIV-positive and HIV-negative individuals without known diabetes or hypertension.
  • To investigate potential early markers of myocardial disease in PLWH.

Main Methods:

  • A cross-sectional study conducted in Western Kenya involving 110 PLWH on ART and matched HIV-uninfected controls.
  • Participants were screened for known diabetes and hypertension and matched for age and sex.
  • Comprehensive two-dimensional echocardiography and laboratory testing were performed on all participants.

Main Results:

  • The prevalence of diastolic dysfunction (DD) was low and similar between HIV-positive (0.9%) and HIV-negative (0.9%) groups.
  • Despite low DD prevalence, people living with HIV (PLWH) exhibited a significantly higher left ventricular mass index (5.76 g/m² higher) and larger left atrial volume (2.77 mL/m² larger) compared to controls.
  • Mean CD4+ T-cell count in the HIV-positive group was 557 cells/ml, and blood pressure and BMI were comparable between groups.

Conclusions:

  • Contrary to prior reports, diastolic dysfunction (DD) was not highly prevalent in people living with HIV (PLWH) on ART in this Western Kenyan cohort.
  • The observed increases in left ventricular mass index and left atrial volume in PLWH suggest subclinical myocardial alterations.
  • Environmental factors and traditional cardiovascular disease risk factors like diabetes and hypertension may significantly influence the development and progression of DD in PLWH.
Abstract

Keywords:
echocardiographyepidemiologyglobal health

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