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HIV, HIV-Specific Factors, and Myocardial Disease in Women

Yoko Kato1, Bharath Ambale-Venkatesh2, Mahim Naveed3,4

  • 1Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.

Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America
|February 15, 2024
PubMed

Insights

Women with HIV on antiretroviral therapy show increased heart inflammation and fibrosis, especially with unsuppressed viral load or low CD4 counts. This highlights the need for better adherence strategies to prevent cardiac damage.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Medical Imaging

Background:

  • People with human immunodeficiency virus (HIV) have higher cardiovascular disease (CVD) risk.
  • Cardiac magnetic resonance (CMR) shows increased myocardial fibrosis, inflammation, and steatosis in people with HIV (PWH).
  • Previous studies often used healthy volunteers and focused on men, limiting understanding in women.

Purpose of the Study:

  • To investigate associations between HIV and specific factors with CMR-derived cardiac phenotypes in women.
  • To assess myocardial fibro-inflammation, fibrosis, and steatosis in women with HIV (WWH).

Main Methods:

  • Utilized data from the Women's Interagency HIV Study.
  • Assessed myocardial native T1 (fibro-inflammation), extracellular volume fraction (fibrosis), and triglyceride content (steatosis) via CMR.
  • Employed multivariable linear regression and meta-analysis to evaluate associations.

Main Results:

  • Women with HIV exhibited higher myocardial native T1 (fibro-inflammation) compared to women without HIV.
  • Higher native T1 was more pronounced with viremia or low nadir CD4+ counts.
  • Low CD4+ counts were also linked to increased extracellular volume fraction (fibrosis); less steatosis was observed in WWH with low CD4+ counts.

Conclusions:

  • Women with HIV on antiretroviral therapy (ART) demonstrate elevated myocardial fibro-inflammation compared to HIV-negative women.
  • This fibro-inflammation is exacerbated by unsuppressed viremia or CD4+ lymphopenia.
  • Findings underscore the need for improved ART adherence and understanding of latent infection to reduce cardiac end-organ damage.
Abstract

Keywords:
HIVWomen's Interagency HIV Study (WIHS)antiretroviral therapycardiac magnetic resonancemyocardial fibro-inflammation

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