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Association of SARS-CoV-2 Infection and Cardiopulmonary Long COVID with Exercise Capacity and Chronotropic
Insights
People with HIV (PWH) show reduced exercise capacity and chronotropic incompetence compared to those without HIV. Long COVID symptoms (PASC) were linked to higher rates of chronotropic incompetence in PWH.
Area of Science:
- Cardiology
- Infectious Diseases
- Pulmonology
Background:
- Long COVID is linked to decreased exercise capacity.
- The impact of SARS-CoV-2 infection and Long COVID on exercise capacity in people with HIV (PWH) remains understudied.
- Cardiopulmonary post-acute symptoms of COVID-19 (PASC) may reduce exercise capacity in PWH due to chronotropic incompetence.
Conclusions:
- PWH demonstrate lower exercise capacity and chronotropic function than individuals without HIV.
- In PWH, SARS-CoV-2 infection and PASC were not strongly linked to reduced exercise capacity.
- Chronotropic incompetence may be a key factor limiting exercise capacity in PWH.
Background:
Long COVID has been associated with reduced exercise capacity, but whether SARS-CoV-2 infection or Long COVID is associated with reduced exercise capacity among people with HIV (PWH) has not been reported. We hypothesized that PWH with cardiopulmonary post-acute symptoms of COVID-19 (PASC) would have reduced exercise capacity due to chronotropic incompetence.
Methods:
We conducted cross-sectional cardiopulmonary exercise testing within a COVID recovery cohort that included PWH. We evaluated associations of HIV, prior SARS-CoV-2 infection, and cardiopulmonary PASC with exercise capacity (peak oxygen consumption, VO 2 ) and adjusted heart rate reserve (AHRR, chronotropic measure) with adjustment for age, sex, and body mass index.
Results:
We included 83 participants (median age 54, 35% female). All 37 PWH were virally suppressed; 23 (62%) had prior SARS-CoV-2 infection, and 11 (30%) had PASC. Peak VO 2 was reduced among PWH (80% predicted vs 99%; p=0.005), a difference of 5.5 ml/kg/min (95%CI 2.7-8.2, p<0.001). Chronotropic incompetence more prevalent among PWH (38% vs 11%; p=0.002), and AHRR was reduced among PWH (60% vs 83%, p<0.0001). Among PWH, exercise capacity did not vary by SARS-CoV-2 coinfection, but chronotropic incompetence was more common among PWH with PASC: 3/14 (21%) without SARS-CoV-2, 4/12 (25%) with SARS-CoV-2 without PASC, and 7/11 (64%) with PASC (p=0.04 PASC vs no PASC).
Conclusions:
Exercise capacity and chronotropy are lower among PWH compared to SARS-CoV-2 infected individuals without HIV. Among PWH, SARS-CoV-2 infection and PASC were not strongly associated with reduced exercise capacity. Chronotropic incompetence may be a mechanism limiting exercise capacity among PWH.
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