P5419Influence of HIV infection on cardiac structure and function in the era of HAART: a systematic review and meta-analysis of case-control studies

Abstract

Background: Human immunodeficiency virus (HIV) infection is associated with a heightened risk of heart failure, but limited data are available regarding the impact of HIV on cardiac structure and function in the era of highly active antiretroviral therapy (HAART). Purpose: To compare cardiac structure and function in treated HIV patients free of cardiovascular disease with uninfected controls. Methods: We systematically searched PubMed for studies reporting cardiac function and/or structure in asymptomatic HIV patients on HAART and uninfected controls. Inclusion criteria were cardiac imaging data on both HIV patients and controls without cardiovascular disease. Exclusion criteria were studies in children (age <18 years) and studies where less than 80% of HIV patients were receiving HAART. Statistical pooling of mean difference in E/A ratio, left ventricular mass index (LVMI) and left ventricular ejection fraction (LVEF) between HIV patients and uninfected controls across studies was performed with a random-effect model with inverse-variance weighting. Results: The search yielded 525 hits in PubMed of which 20 were selected for full text reading, and 14 studies were included in the review (10 echocardiographic studies and 4 MRI studies; reasons for exclusion were multiple studies from same cohort and <80% of HIV patients on HAART). E/A ratio was available in 7 echo studies, LVMI in 7 studies (6 echo and 1 MRI) and LVEF in 10 studies (10 echo and 3 MRI). Comparing HIV patients to controls, HIV-patients demonstrated lower E/A ratio [-0.12 (-0.19 to -0.05); p=0.001; I2=10%; left panel] and higher LVMI [7.2 (3.4 to 10.9) g/m2; p<0.001; I2=64%; middle panel]. HIV was associated with lower LVEF [-2.1% (-3.7 to -0.4; p=0.01; I2=78%; right panel) despite overall normal LVEF (mean LVEF for HIV patients ranged from 58% to 68% across studies). Conclusions: In the era of HAART, asymptomatic HIV infection is associated with impairments in cardiac structure and function; these alterations may underlie the heighted risk of heart failure associated with HIV. (Table Presented).