Immune Correlates of Diffuse Myocardial Fibrosis and Diastolic Dysfunction Among Aging Women With Human Immunodeficiency Virus

Zanni, Markella V.; Awadalla, Magid; Toribio, Mabel; Robinson, Jake A.; Stone, Lauren; Cagliero, Diana; Rokicki, Adam; Mulligan, Connor P.; Ho, Jennifer E.; Neilan, Anne M.; Siedner, Mark J.; Triant, Virginia A.; Stanley, Takara L.; Szczepaniak, Lidia S.; Jerosch‐Herold, Michael; Nelson, Michael D.; Burdo, Tricia H.; Neilan, Tomas G.

doi:10.1093/infdis/jiz184

Cited by 42 publications

(74 citation statements)

References 14 publications

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“…Table 3 presents clinical characteristics and CMR imaging parameters for studies that compared PWH and uninfected controls within the United Kingdom and the United States [ 38–41 ]. When compared with these cohorts from HICs, our study had higher proportion of women (except for Zanni et al [ 41 ] who studied only women) and higher prevalence of hypertension. Differences in magnetic resonance imaging systems between the studies limit direct comparisons of T1 mapping parameters used to inform ECV.…”

Section: Resultsmentioning

confidence: 71%

“…Differences in magnetic resonance imaging systems between the studies limit direct comparisons of T1 mapping parameters used to inform ECV. However, in HICs, HIV status had a large effect on the presence of LGE and a consistent effect on ECV that was greatest among the cohort that only studied women (Zanni et al [ 41 ]). The difference in ECV in an LMIC in our study is consistent with these data from HICs, but they did not detect a difference in LGE due to the higher proportion of uninfected persons with LGE in SA when compared with the United Kingdom.…”

Section: Resultsmentioning

confidence: 99%

“… Abbreviations: ART, antiretroviral therapy; BMI, body mass index; CMR, cardiac magnetic resonance; ECV, extracellular volume; EF, ejection fraction; LGE, late-gadolinium enhancement; LV, left ventricular; MI, mass index; NA, not applicable; PWH, persons with human immunodeficiency virus; SD, standard deviation. NOTE: Postcontrast T1 mapping for ECV estimates were not obtained in Ntusi et al [ 38 ]; postcontrast T1 mapping time point used was 20 minutes for ECV reported for Luetkens et al [ 39 ]; both Thiara et al [ 40 ] and Zanni et al [ 41 ] assessed postcontrast T1 mapping at 10 and 25 minutes. …”

Section: Resultsmentioning

confidence: 99%

“… NOTE: Postcontrast T1 mapping for ECV estimates were not obtained in Ntusi et al [ 38 ]; postcontrast T1 mapping time point used was 20 minutes for ECV reported for Luetkens et al [ 39 ]; both Thiara et al [ 40 ] and Zanni et al [ 41 ] assessed postcontrast T1 mapping at 10 and 25 minutes. …”

Section: Resultsmentioning

confidence: 99%

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Myocardial Fibrosis Among Antiretroviral Therapy-Treated Persons With Human Immunodeficiency Virus in South Africa

Shuldiner

Wong

Peterson

et al. 2020

Open Forum Infectious Diseases

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Background Heart failure is a prominent cardiovascular disease (CVD) manifestation in sub-Sarahan Africa. Myocardial fibrosis is a central feature of heart failure that we aimed to characterize among persons with human immunodeficiency virus (PWH) in South Africa. Methods Cardiovascular magnetic resonance (CMR) imaging was performed among PWH with viral suppression and uninfected controls, both free of known CVD. Plasma levels of N-terminal pro B-type natriuretic peptide (NT-proBNP) were measured. Comparisons by human immunodeficiency virus (HIV) status were made using linear and logistic regression, adjusted for age, sex, and hypertension. Results One hundred thirty-four PWH and 95 uninfected persons completed CMR imaging; age was 50 and 49 years, with 63% and 67% female, respectively. Compared with controls, PWH had greater myocardial fibrosis by extracellular volume fraction ([ECV] absolute difference, 1.2%; 95% confidence interval [CI], 0.1–2.3). In subgroup analyses, the effect of HIV status on ECV was more prominent among women. Women (vs controls) were also more likely to have elevated NT-proBNP levels (>125 pg/mL; odds ratio, 2.4; 95% CI, 1.0–6.0). Among all PWH, an elevated NT-proBNP level was associated with higher ECV (3.4% higher; 95% CI, 1.3–5.5). Conclusions Human immunodeficiency virus disease may contribute to myocardial fibrosis, with an effect more prominent among women. Research is needed to understand heart failure risk among PWH within sub-Saharan Africa.

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Section: Resultsmentioning

confidence: 71%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Myocardial Fibrosis Among Antiretroviral Therapy-Treated Persons With Human Immunodeficiency Virus in South Africa

Shuldiner

Wong

Peterson

et al. 2020

Open Forum Infectious Diseases

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“…Women living with HIV (WLWH) in North America and Europe are estimated to have 2 to 4 times higher risk of myocardial infarction, stroke and heart failure as compared to women without HIV infection and approximately equivalent risk compared to men living with HIV (MLWH). [78][79][80][81] The reasons behind this elevated risk are multifactorial, including 1) increased levels of systemic inflammation and interaction with sex-specific hormones, 82 2) sub-optimal implementation of guideline-directed preventive therapy for traditional cardiometabolic risk factors, 83 and 3) heightened levels of behavioral and psychosocial risk factors as compared to the general population. 84 Whether relationships between sex and CVD risk are similar in SSA as elsewhere is unknown.…”

Section: Sexmentioning

confidence: 99%

Prevention of cardiovascular disease among people living with HIV in sub-Saharan Africa

Okello

Almasi‐Hashiani

Bloomfield

et al. 2020

Progress in Cardiovascular Diseases

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As longevity has increased for people living with HIV (PLWH) in the United States and Europe, there has been a concomitant increase in the prevalence of cardiovascular disease (CVD) risk factors and morbidity in this population. Whereas the availability of HIV antiretroviral therapy has resulted in dramatic increases in life expectancy in sub-Saharan Africa (SSA), where over two thirds of PLWH reside, if and how these trends impact the epidemiology of CVD is less clear. In this review, we describe the current state of the science on how both HIV and its treatment impact CVD risk factors and outcomes among PLWH in sub-Saharan Africa, including regional factors (unique to SSA) likely to differentiate these relationships from the global North. We then outline how current regional guidelines address CVD prevention among PLWH and which clinical and structural interventions are best poised to confront the co-epidemics of HIV and CVD in the *

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Association of HIV Infection With Cardiovascular Pathology Based on Advanced Cardiovascular Imaging

Hudson

Majonga

Ferrand

et al. 2022

JAMA

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IMPORTANCE HIV-associated cardiovascular disease is increasing in prevalence, but its mechanisms remain poorly understood.OBJECTIVE To systematically review data from advanced cardiovascular imaging studies evaluating computed tomographic coronary angiography, positron emission tomography (PET), and cardiac magnetic resonance (MR), in people living with HIV compared with uninfected individuals.DATA SOURCES Three databases and Google Scholar were searched for studies assessing cardiovascular pathology using computed tomographic coronary angiography, cardiac MR, PET, and HIV from inception to February 11, 2022.STUDY SELECTION Two reviewers selected original studies without any restrictions on design, date, or language, investigating HIV and cardiovascular pathology. DATA EXTRACTION AND SYNTHESISOne investigator extracted data checked by a second investigator. Prevalence ratios (PRs) and differences in inflammation among people living with HIV and uninfected individuals were qualitatively synthesized in terms of cardiovascular pathology. Study quality was assessed using the National Heart, Lung, and Blood Institute quality assessment tool for observational studies.MAIN OUTCOMES AND MEASURES Primary outcomes were computed tomographic coronary angiography-defined moderate to severe (Ն50%) coronary stenosis, cardiac MR-defined myocardial fibrosis identified by late gadolinium enhancement, and PET-defined vascular and myocardial target to background ratio. Prevalence of moderate to severe coronary disease, as well as myocardial fibrosis, and PRs compared with uninfected individuals were reported alongside difference in vascular target to background ratio.RESULTS Forty-five studies including 5218 people living with HIV (mean age, 48.5 years) and 2414 uninfected individuals (mean age, 49.1 years) were identified. Sixteen studies (n = 5107 participants) evaluated computed tomographic coronary angiography; 16 (n = 1698), cardiac MRs; 10 (n = 681), vascular PET scans; and 3 (n = 146), both computed tomographic coronary angiography and vascular PET scans. No studies originated from low-income countries. Regarding risk of bias, 22% were classified as low; 47% moderate; and 31% high. Prevalence of moderate to severe coronary disease among those with vs without HIV ranged from 0% to 52% and 0% to 27%, respectively, with PRs ranging from 0.33 (95% CI, 0.01-15.90) to 5.19 (95% CI,). Prevalence of myocardial fibrosis among those with vs without HIV ranged from 5% to 84% and 0% to 68%, respectively, with PRs ranging from 1.01 (95% CI, 0.85-1.21) to 17.35 (95% CI,. Differences in vascular target to background ratio among those with vs without HIV ranged from 0.06 (95% CI, 0.01-0.11) to 0.37 (95% CI, 0.02-0.72). CONCLUSIONS AND RELEVANCEIn this systematic review of studies of advanced cardiovascular imaging, the estimates of the associations between HIV and cardiovascular pathologies demonstrated large amounts of heterogeneity. The findings provide a summary of the available data but may not be representative of all individuals living...

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Immune Correlates of Diffuse Myocardial Fibrosis and Diastolic Dysfunction Among Aging Women With Human Immunodeficiency Virus

Cited by 42 publications

References 14 publications

Myocardial Fibrosis Among Antiretroviral Therapy-Treated Persons With Human Immunodeficiency Virus in South Africa

Myocardial Fibrosis Among Antiretroviral Therapy-Treated Persons With Human Immunodeficiency Virus in South Africa

Prevention of cardiovascular disease among people living with HIV in sub-Saharan Africa

Association of HIV Infection With Cardiovascular Pathology Based on Advanced Cardiovascular Imaging

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