Long-term subclinical cardiac damage in people living with human immunodeficiency virus

Human immunodeficiency virus (HIV) infection remains a major global health challenge. People living with HIV are twice as likely to develop cardiovascular disease. Myocardial work is a novel echocardiographic technique that assesses global work index and global work efficiency of the left ventricle, enabling earlier detection of subclinical myocardial dysfunction.

We conducted a cross-sectional study of patients with long-standing HIV infection without previous cardiovascular disease, aiming to evaluate the prevalence of subclinical cardiac dysfunction determined by an impaired global myocardial work efficiency, and studied its predictors by linear regression.

110 HIV patients (78.2% men) were included, median age 53.3 years and median time since diagnosis of 20.5 years. Echocardiographic measurements were compared with matched control participants. HIV patients showed significantly lower values of global longitudinal strain of the left ventricle, right ventricle free wall and left atrial reservoir, although absolute values remained within normal limits. HIV group had consistently reduced global work efficiency values (≤93%) which was associated with by age, diabetes, SCORE2, time from diagnosis, long corrected QT interval, QRS Interval duration, CD4 count nadir, initial and maximum viral load and exposure to didanosine by univariate analysis. After adjustment by SCORE2 and QRS duration, global work efficiency reduction depended on maximum viral load.

Subclinical myocardial dysfunction is present in long-standing HIV infection. Global work efficiency may represent a sensitive marker of subclinical myocardial dysfunction, even in patients with preserved left ventricular ejection fraction, and it was associated with maximum viral load in our patients.