“Myocardial inflammatory changes before and after antiretroviral therapy initiation in people with advanced HIV disease”

Piñeirúa-Menéndez, Alicia; Flores-Miranda, Rommel; Sánchez-Nava, D; Ortega-Pérez, Raúl; Belaunzarán-Zamudio, Pablo F; Pérez-Patrigeón, Santiago; Cárdenas-Ochoa, Ayleen; Oseguera-Moguel, Jorge; Galindo-Uribe, Jaime; Orihuela-Sandoval, Consuelo; Vázquez-Ortíz, Zuilma; Vázquez-Lamadrid, Jorge; Morelos-Guzmán, Martha; Rosales-Uvera, Sandra; Crabtree-Ramírez, Brenda; Sierra‐Madero, Juan

doi:10.1093/ofid/ofaa297

Cited by 5 publications

(4 citation statements)

References 20 publications

(16 reference statements)

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“…Thus, it is crucial to identify risk factors associated with the presence of LGE in HIV-infected patients. In addition, few CMR studies ( 17 ) focus on patients in the late stage of HIV disease despite the cardiac complications that occurred more frequently in those patients compared with patients in the early stage. Furthermore, no CMR study to date has assessed the myocardial involvement among the Chinese HIV/AIDS cohort.…”

Section: Introductionmentioning

confidence: 99%

Cardiac Involvement in Human Immunodeficiency Virus Infected Patients: An Observational Cardiac Magnetic Resonance Study

Yan

Guo

et al. 2021

Front. Cardiovasc. Med.

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Objectives: To investigate the subclinical imaging changes in terms of myocardial inflammation and fibrosis and to explore the risk factors associated with myocardial fibrosis by cardiac magnetic resonance (CMR) approach in a Chinese HIV/AIDS cohort.Methods: We evaluated myocardial function (cine), myocardial inflammation (T1, T2), and myocardial fibrosis (through extracellular volume fraction [ECV] and late gadolinium enhancement [LGE]) by a multiparametric CMR scan protocol in a total of 68 participants, including 47 HIV-infected individuals, who were divided into two groups: asymptomatic HIV (HIV+) (n = 30), and acquired immunodeficiency syndrome (AIDS) (n = 17), and 21 healthy controls.Results: HIV-infected patients had lower left (55.3 ± 6.5 vs. 63.0 ± 7.9%, P < 0.001) and right ventricular systolic function (35.9 ± 15.7 vs. 50.8 ± 9.3%, P < 0.001). Radial systolic strain (30.7 ± 9.3 vs. 39.3 ± 9.4%, P = 0.001), circumferential systolic strain (−17.5 ± 2.6 vs. −19.4 ± 2.7%, P = 0.008), and longitudinal systolic strain (−9.4 ± 5.7 vs. −12.8 ± 3.1%, P = 0.012) were also decreased in HIV. Native T1 relaxation time (1,337.2 ± 70.2 vs. 1,249.5 ± 47.0 ms, P < 0.001), ECV value (33.5 ± 6.2 vs. 28.5 ± 2.9 ms, P = 0.026), and T2 relaxation time (45.2 ± 3.5 vs. 42.0 ± 2.6 ms, P = 0.001) were higher in HIV-infected patients compared with controls. Myocardial fibrosis, predominantly in the mid-inferior wall, was detected in 24.4% of the HIV-infected patients. HIV+ had a significantly lower value of ECV [29.1 (26.1, 31.8) vs. 35.2 (31.8, 41.9) %, P < 0.001] and frequency of LGE [3/25 (8%) vs. 7/16 (43.8%), P = 0.014)] compared with AIDS. AIDS was associated with myocardial fibrosis.Conclusions: HIV-infected patients were associated with changes in myocardial function and higher rates of subclinical myocardial inflammation and fibrosis, which were more abnormal with greater severity of the disease. AIDS was associated with myocardial fibrosis, where the observations supported earlier initiation of antiretroviral therapy in the Chinese HIV/AIDS cohort.

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Section: Introductionmentioning

confidence: 99%

Cardiac Involvement in Human Immunodeficiency Virus Infected Patients: An Observational Cardiac Magnetic Resonance Study

Yan

Guo

et al. 2021

Front. Cardiovasc. Med.

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“…Sixteen studies involving 5107 participants, 3446 of whom were HIV positive and 1661 were HIV negative, evaluated computed tomographic coronary angiography . Another 16 studies involving 1698 participants, 1203 of whom were HIV positive and 495 were HIV negative, evaluated cardiac MR imaging . Ten studies involving 681 participants, 435 of whom were HIV positive and 246 were HIV negative, evaluated vascular PET scans .…”

Section: Resultsmentioning

confidence: 99%

“…Of the 45 studies, 38 were conducted in high-income countries (49% in the US) with 7 in upper middle-income countries (Figure 1). No studies were performed in low-income countries. The study designs were cross-sectional (85%), prospective cohort (13%), and randomized clinical trial (2%).…”

Section: Resultsmentioning

confidence: 99%

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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“…While these findings may hint toward the possibility of an immune reconstitution syndrome propagating myocardial inflammation, others have demonstrated the protective effect of ART. 190 Robbertse et al 48 demonstrated a reduction of magnetic resonance imaging–based parameters of myocardial fibrosis (global native T1 times and extracellular volume fraction) following ART initiation with a concurrent improvement in CD4 counts and viral load suppression. Although this study did not assess clinical outcomes, measure myocardial inflammatory cell infiltration, or assess correlations with circulating markers of cardiac injury, it demonstrates 2 important points.…”

Section: Mechanisms Of Coronary Artery Disease In Hiv Infectionmentioning

confidence: 99%

HIV-Associated Cardiovascular Disease Pathogenesis: An Emerging Understanding Through Imaging and Immunology

Hudson,

Ferrand,

Gitau

et al. 2024

Circulation Research

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Cardiac abnormalities were identified early in the epidemic of AIDS, predating the isolation and characterization of the etiologic agent, HIV. Several decades later, the causation and pathogenesis of cardiovascular disease (CVD) linked to HIV infection continue to be the focus of intense speculation. Before the widespread use of antiretroviral therapy, HIV-associated CVD was primarily characterized by HIV-associated cardiomyopathy linked to profound immunodeficiency. With increasing antiretroviral therapy use, viral load suppression, and establishment of immune competency, the effects of HIV on the cardiovascular system are more subtle. Yet, people living with HIV still face an increased incidence of cardiovascular pathology. Advances in cardiac imaging modalities and immunology have deepened our understanding of the pathogenesis of HIV-associated CVD. This review provides an overview of the pathogenesis of HIV-associated CVD integrating data from imaging and immunologic studies with particular relevance to the HIV population originating from high-endemic regions, such as sub-Saharan Africa. The review highlights key evidence gaps in the field and suggests future directions for research to better understand the complex HIV-CVD interactions.

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“Myocardial inflammatory changes before and after antiretroviral therapy initiation in people with advanced HIV disease”

Cited by 5 publications

References 20 publications

Cardiac Involvement in Human Immunodeficiency Virus Infected Patients: An Observational Cardiac Magnetic Resonance Study

Cardiac Involvement in Human Immunodeficiency Virus Infected Patients: An Observational Cardiac Magnetic Resonance Study

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

HIV-Associated Cardiovascular Disease Pathogenesis: An Emerging Understanding Through Imaging and Immunology

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