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Published on: July 24, 2013
Structural Cardiac Abnormalities, Ventricular Dysfunction Phenotypes, and Heart Failure Risk among Antiretroviral
Zaayid Omar1, Abdullahi M Ahmed2, Julian Wolfson3
1Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, South Africa.
Insights
Heart failure with preserved ejection fraction (HFpEF) is more common in people with HIV (PWH) in South Africa, particularly women. Early detection strategies are needed for this vulnerable population.
Area of Science:
- Cardiology
- Infectious Diseases
- Public Health
Background:
- Cardiovascular disease (CVD) manifestations in people with HIV (PWH) vary globally, with non-ischemic heart failure (HF) prevalent in sub-Saharan Africa.
- This study investigated the impact of treated HIV on HF frequency and cardiac precursors in South Africa, a region with a high HIV burden.
Purpose of the Study:
- To estimate the effect of treated HIV on the frequency and phenotype of heart failure (HF) and its cardiac precursors in South Africa.
- To identify specific cardiac abnormalities and HF subtypes associated with HIV infection in this population.
Main Methods:
- An observational study enrolled 1008 PWH on antiretroviral therapy (ART) and 500 people without HIV (PWoH) aged ≥40 years in Cape Town, South Africa.
- Clinical assessment, echocardiography (Echo), and b-type natriuretic peptide (BNP) measurements were performed to define HF and cardiac structural/functional parameters.
- Statistical analyses adjusted for key cardiometabolic risk factors and explored interactions by sex.
Main Results:
- Heart failure with preserved ejection fraction (HFpEF) was the predominant HF phenotype (8%) among PWH and controls, with overall HF frequency at 10%.
- PWH showed higher odds of elevated left ventricle mass index (LVMI) and diastolic dysfunction (DD) compared to controls.
- Women with HIV had a significantly increased risk for elevated LVMI, DD, and undiagnosed HFpEF compared to women without HIV.
Conclusions:
- In a South African community with high cardiometabolic risk, ART-treated PWH exhibited more frequent cardiac precursors of HFpEF.
- The increased risk for HFpEF precursors and HFpEF itself was most pronounced in women with HIV.
- Findings highlight the need for targeted screening and further research into the interplay of HIV, sex, and adiposity in HFpEF pathogenesis.
Background:
The manifestations of cardiovascular disease (CVD) among people with HIV (PWH) differ by region globally. While HIV disease is associated with increased atherosclerotic CVD risk in the global North, non-ischemic heart failure (HF) is more common in sub-Saharan Africa, the global HIV epicenter. We estimated the effect of treated HIV on the frequency and phenotype of HF and its cardiac precursors in South Africa (SA).
Methods:
In an observational study, we recruited PWH on antiretroviral therapy (ART), age ≥40 years and people without HIV (PWoH) with similar distributions of age, sex, ethnicity, and hypertension, from a community clinic in Khayelitsha (Cape Town, SA). Procedures included a clinical assessment, echocardiography (Echo), and b-type natriuretic peptide (BNP) measure. Echo parameters defined structural abnormalities, left ventricle (LV) filling pressure, and LV systolic and diastolic dysfunction (DD). HF was defined by symptoms and/or BNP ≥35pg/mL and LV dysfunction, subcategorized as reduced, mildly reduced, or preserved ejection fraction (HFrEF, HFmrEF, and HFpEF). Comparisons by HIV status were adjusted for age, sex, hypertension, smoking, obesity, diabetes, elevated LDL-cholesterol, and hazardous alcohol use.
Results:
Between September 2022 and August 2025, we enrolled 1008 PWH and 500 controls [median (Q1-Q3) age 48 years (43-53), 77% female]. Among PWH and controls respectively, 37% and 39% had hypertension, 21% and 25% were current smokers, 40% and 45% were obese, and 9% and 17% had diabetes. LV systolic dysfunction (1%) and HFrEF (1%) were rare, and undiagnosed HFpEF (8%) was the predominant HF phenotype. Compared to controls, PWH had higher odds of elevated LV mass index (LVMI) (OR 2.1; 95%CI 1.5-3.0) and DD (OR 1.4; 95%CI 1.0-2.0). Risk for elevated LVMI and DD was greatest among women with HIV, who also had an increased risk for undiagnosed HFpEF (OR 1.9; 95%CI 1.2-3.2), compared to women without HIV; effects which were not seen among men (p=0.051 for HIV*Sex interaction).
Conclusions:
In a peri-urban SA community with a high burden of cardiometabolic risk factors, the frequency of abnormal structural and functional cardiac precursors of HFpEF was greater amongst ART-treated PWH. This was most pronounced amongst women with HIV, who also had increased risk of undiagnosed HFpEF.
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