Electrocardiograms and screening echocardiograms in young adults who acquired HIV perinatally and non-perinatally: a pilot study

Lifelong exposure to HIV and antiretroviral therapy (ART) may elevate cardiovascular risk as individuals with perinatally acquired HIV transition into adulthood. We evaluated subclinical electrocardiographic (ECG) and echocardiographic abnormalities in this population.

A cross-sectional study was conducted in Thailand between 2022-2023. Young adults who acquired HIV perinatally were enroled, alongside age-matched adults who acquired HIV non-perinatally. Participants underwent standard ECG and screening echocardiography.

A total of 62 participants (31 who acquired HIV perinatally and 31 non-perinatally) were included in the study. Of these, 31 (50.0%) were men, and the median (interquartile range; IQR) age was 25.4 (23.9-27.0) years. The median (IQR) CD4 + count was 595 (453-835) cells/mm³. Yong adults with perinatal HIV had longer HIV/ART exposure and greater historical use of zidovudine, stavudine, and protease inhibitors. Abnormal ECG findings were present in participants with perinatally acquired HIV and non-perinatally acquired HIV, including sinus bradycardia (16.1% vs. 12.9%), low-voltage QRS (12.9% vs. 3.2%), ST-T abnormalities (6.5% vs. 3.2%), and QTc prolongation (3.2% vs. 3.2%). Abnormal echocardiograms were observed, including hyperdynamic left ventricular ejection fraction (LVEF > 70%) occurring in 9.7% vs. 0.0% (p = 0.238). In multivariable analysis, incomplete virologic suppression (viral load ≥ 200 copies/mL) was independently associated with low-voltage ECG (odds ratio 8.57; 95% confidence interval 1.16-63.30; p = 0.035).

Subclinical cardiac abnormalities were infrequent and comparable between young adults with perinatally and non-perinatally acquired HIV. Low-voltage ECG was associated with incomplete virologic suppression. Optimising antiretroviral regimens to maintain a suppressed viral load may help reduce subclinical cardiac abnormalities in young people with HIV.