US investigators have found a high prevalence of asymptomatic heart problems in HIV-positive patients. The study, presented to the recent 15th Conference on Retroviruses and Opportunistic Infections last week, showed that although antiretroviral therapy appeared to be a contributory factor, so too was smoking and the use of recreational drugs such as poppers and cannabis. They therefore recommend that life-style modification should be a “high priority” in the management of chronic HIV infection.
There is accumulating evidence that HIV-positive patients have an increased risk of cardiovascular disease. The Study to Understand the Natural History of HIV/AIDS in the Era of Effective Therapy (SUN Study) is a prospective cohort study involving patients recruited from seven US cities. Investigators conducted cardiac ultrasounds on 643 patients HIV-positive patients to establish the factors associated with asymptomatic heart disorders.
Echocardiographs were performed to check for the presence of left ventricular systolic dysfunction, diastolic dysfunction, pulmonary hypertension, left ventricular hypertrophy, and left atrial enlargement. All these conditions can exist without symptoms, but are indicators of heart disease.
Most of the patients (77%) were men, 61% were white, and the mean age was 41 years. The mean time since HIV diagnosis was six years and 19% of patients had previously been diagnosed with an opportunistic infection. A significant number of patients had risk factors for heart disease with 44% being smokers and 11% having high blood pressure. Levels of recreational drug use were high and a quarter of patients were current cannabis users, 17% inhaled poppers, and 10% used cocaine. All the patients had a CD4 cell count above 100 cells/mm3.
Cardiac ultrasounds showed that 11% of patients had left ventricular systolic dysfunction, 25% had diastolic dysfunction, 18% had pulmonary hypertension, 6% had ventricular hypertrophy and 40% had left atrial enlargement.
Some risk factors for these conditions, such as male sex for systolic dysfunction (p = 0.013) and age over 46 years for left atrial enlargement (p = 0.012) were not modifiable.
There was also evidence suggesting a link between anti-HIV therapy and cardiac disorders. Treatment with a ritonavir-boosted protease inhibitor was a significant risk factor for pulmonary hypertension (p = 0.019), and AZT therapy was significantly associated with left ventricular hypertrophy (p = 0.03).
But the investigators also found that there were modifiable risk factors for some disorders. Elevated total cholesterol was associated with pulmonary hypertension (p = 0.04), and being over-weight was a significant risk for left ventricular hypertrophy (p < 0.001).
Smoking and recreational drug use were also important factors. Current smoking was a significant risk for systolic dysfunction (p = 0.004), use of poppers in the previous month for diastolic dysfunction (p = 0.03), and cannabis use within the previous six months for left ventricular hypertrophy (p < 0.001) and for left atrial enlargement (p = 0.006).
“Subtle abnormalities in cardiac function were prevalent within this patient cohort”, conclude the investigators. They note that such abnormalities were not only associated with traditional cardiac risk factors but also with “modifiable factors such as illicit drug use.”
They recommend “lifestyle modification should be a high priority in the management of chronic HIV disease.”
Mondy K et al. Prevalence of risk factors in HIV-infected persons for echocardiographic abnormalities in the era of modern HAART. Fifteenth Conference on Retroviruses and Opportunistic Infections, Boston, abstract 978, 2008.