In order to bring you the best possible user experience, this site uses Javascript. If you are seeing this message, it is likely that the Javascript option in your browser is disabled. For optimal viewing of this site, please ensure that Javascript is enabled for your browser.

The free consultation period for this content is over.

It is now only available year-round to HFA Silver & Gold Members, Fellows of the ESC and Young combined Members

Left ventricular dysfunction in HIV infected anti-retroviral therapy naive patients

Session Poster Session 3

Speaker Charalampos Mystakelis

Event : Heart Failure 2019

  • Topic : heart failure
  • Sub-topic : Chronic Heart Failure: Comorbidities
  • Session type : Poster Session

Authors : C Mystakelis (Bethesda,US), A Lisco (Bethesda,US), M Manion (Bethesda,US), A Rupert (Frederick, MD,US), G Roby (Frederick, MD,US), V Sheikh (Bethesda,US), I Sereti (Bethesda,US)

Authors:
C Mystakelis1 , A Lisco1 , M Manion1 , A Rupert2 , G Roby2 , V Sheikh1 , I Sereti1 , 1National Institutes of Health, National Institute of Allergy and Infectious Diseases - Bethesda - United States of America , 2Leidos Biomedical Research, AIDS Monitoring Laboratory - Frederick, MD - United States of America ,

Citation:

Background
Cardiovascular disease is one of the leading causes of mortality in individuals with chronic human immunodeficiency virus (HIV) infection.  In particular, antiretroviral therapy (ART) naïve patients with low CD4+ counts have higher incidence of co-infections, systemic inflammation and coagulopathy which can be associated with both ischemic and non-ischemic cardiomyopathy. The prevalence of heart failure/left ventricular dysfunction in ART naïve individuals with severe CD4 lymphopenia is unknown. 

Objective
Identify the prevalence of left ventricular dysfunction/heart failure in patients with less than 100 CD4+ T cells/µL at the time of ART initiation and identification of immunological correlates that can guide management.

Methods
206 HIV+ ART naïve patients with CD4<100 cells/µL were included in a prospective study and followed longitudinally for 192 weeks after ART initiation. Demographic, virologic and clinical data were analyzed. Plasma cytokines were measured with ELISA and electrochemiluminescence assays. Echocardiograms were performed as clinically indicated. Statistical analyses were performed using Mann-Whitney non-parametric tests.

Results
The median age at enrollment was 38 years old (yo),(range: 21-75), 75.7% of the patients were male and 57.7% were African American. The median HIV viral load (VL) was 138,005 copies/ml and the median CD4 was 24 cells/µl. Out of the 206 patients, 80 had an echocardiogram, 67 of which were performed in the first 100 days of ART (64% male, median age 41yo). 13 out of these 67 patients (19%) had reduced ejection fraction (EF <50%) and 6 out of these 13 had EF<40%. Four patients had right ventricular systolic pressure > 40 mm Hg. The median CD4 count and HIV viral load of the patients with echocardiographic abnormalities on the day of the study did not differ from those without echocardiographic abnormalities (14 cells/µl vs 32 cells/ µl, p=0.0793, and 108,444 copies/ml vs 28,279 copies/ml, p=0.3059). Patients with ventricular dysfunction had significantly higher plasma levels of D-Dimer (1719 vs 949.8 ng/ml), (p=0.0271) and IL-6 (4.288 vs 1.656 pg/ml), (p<0.0001) prior to ART. No significant differences were found in plasma levels of TNF, CRP and sCD14.From the 17 patients with evidence of ventricular dysfunction, 11 had a follow up echocardiogram, out of which 5 had ventricular function improvement (EF>50) after therapy (median follow up 9 months, range 4-24 months). Two patients died during the first 100 days of ART initiation, of whom one had heart failure with EF<40% and one did not.

Conclusions
Left ventricular dysfunction is an important comorbidity in ART naïve patients with severe lymphopenia and is associated with higher levels of IL-6 and D-dimer. These data suggest that specific cardiac screening for ART-naïve HIV patients with severe lymphopenia should be further evaluated.

Members get more

Join now
  • 1ESC Professional Members – access all resources from general ESC events 
  • 2ESC Association Members (Ivory, Silver, Gold) – access your Association’s resources
  • 3Under 40 or in training - with a Combined Membership, access all resources
Join now

Our sponsors

ESC 365 is supported by Bayer, Boehringer Ingelheim and Lilly Alliance, Bristol-Myers Squibb and Pfizer Alliance, Novartis Pharma AG and Vifor Pharma in the form of educational grants. The sponsors were not involved in the development of this platform and had no influence on its content.

logo esc

Our mission: To reduce the burden of cardiovascular disease

Who we are