Prevalence of Echocardiographic Abnormalities in HIV-Infected Adults on Long-Term Combination Antiretroviral Therapy

Abstract Background The prevalence of cardiac dysfunction in people living with HIV (PLWH) on long-term combination antiretroviral therapy (cART) in Asia remains unclear. This study sought to investigate the prevalence of echocardiographic dysfunction in Chinese PLWH on long-term cART and explore related risk factors. Methods The Chinese Long-Term Antiretroviral Treatment (CLTA) study is a multi-center, prospective cohort study aimed to determine the comorbidities in PLWH treated on long-term cART. 371 PLWH on long-term cART were enrolled in the echocardiographic substudy. 268 cART-Naïve PLWH and 110 HIV-negative individuals were included as control groups after being matched for gender, age and blood pressure. The prevalence of left ventricular systolic dysfunction (LVSD), pulmonary arterial hypertension (PAH) and left ventricular hypertrophy (LVH) was assessed and compared between different groups. Results The median age of the long-term CART (CLTA) group was 41.1 years (83.3% male). The CLTA participants had received cART for a median of 6.2 years with a current CD4+ T cell count 509 cells/mm3. 99.1% of them were viral suppressed. The prevalence of LVSD, PAH and LVH in the CLTA group was 1.1%, 3.9%, 10.3%, respectively. Among 268 pairs of CLTA and cART-Naïve PLWH, CLTA group had a significantly lower prevalence of PAH (4.0% vs 12.7 %, P =0.010). Among 110 pairs of CLTA and HIV-negative controls, the CLTA group had a significantly higher prevalence of LVH than HIV-negative controls (23.8% vs 5.5%, P =0.004). Incomplete immune reconstitution (CD4 <350 cells/mm3, OR=4.286, P =0.007), female gender (OR=18.014, P<0.001) and elevated triglycerides (OR=1.199, P =0.008) were associated with increased risk of LVH in PLWH on long-term cART. Conclusions In this Chinese PLWH on long-term cART cohort, the prevalence of LVSD and PAH are relatively low. Compared with HIV-negative controls, PLWH on long-term cART had a higher prevalence of LVH, which is associated with both traditional CVD risk factors and incomplete immune reconstitution. Trial Registration The study was registered in ClinicalTrials.gov (NCT04463810)