Roozen Geert V T, Meel Ruchika, Peper Joyce, Venter William D F, Barth Roos E, Grobbee Diederick E, Klipstein-Grobusch Kerstin, Vos Alinda G
Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
Division of Cardiology, Department of Internal Medicine, Chris Hani Baragwanath Hospital and University of the Witwatersrand, Johannesburg, South Africa.
PLoS One. 2021 Feb 2;16(2):e0244742. doi: 10.1371/journal.pone.0244742. eCollection 2021.
Studies from high income countries report that HIV-positive people have an impaired systolic and diastolic cardiac function compared to HIV-negative people. It is unclear if results can be translated directly to the Sub-Saharan Africa context. This study assesses electro- and echocardiographic characteristics in an urban African population, comparing HIV-positive people (treated and not yet treated) with HIV-negative controls.
We conducted a cross-sectional study in Johannesburg, South Africa. We enrolled HIV-positive participants from three randomized controlled trials that had recruited participants from routine HIV testing programs. HIV-negative controls were recruited from the community. Data were collected on demographics, cardiovascular risk factors, medical history and electrocardiographic and echocardiographic characteristics.
In total, 394 HIV-positive participants and 153 controls were enrolled. The mean age of HIV-positive participants was 40±9 years (controls: 35±10 years), and 34% were male (controls: 50%). Of HIV-positive participants 36% were overweight or obese (controls: 44%), 23% had hypertension (controls: 28%) and 12% were current smoker (controls: 37%). Median time since HIV diagnosis was 6.0 years (IQR 2.3-10.0) and median treatment duration was 4.0 years (IQR 0.0-8.0), 50% had undetectable viral load. The frequency of anatomical cardiac abnormalities was low and did not differ between people with and without HIV. We observed no relation between HIV or anti-retroviral therapy (ART) and systolic or diastolic heart function. There was an association between ART use and corrected QT interval: +11.8 ms compared to HIV-negative controls (p<0.01) and +18.9 ms compared to ART-naïve participants (p = 0.01). We also observed a higher left ventricular mass index in participants on ART (+7.8 g/m2, p<0.01), but this association disappeared after adjusting for CD4 cell count, viral load and HIV-duration.
The low number of major cardiac abnormalities in this relatively young, well managed urban African HIV-positive population is reassuring. The increase in corrected QT interval and left ventricular mass may contribute to higher cardiac mortality and morbidity in people living with HIV in the long term.
来自高收入国家的研究报告称，与艾滋病毒阴性者相比，艾滋病毒阳性者的心脏收缩和舒张功能受损。尚不清楚这些结果能否直接应用于撒哈拉以南非洲地区的情况。本研究评估了非洲城市人群的心电图和超声心动图特征，比较了艾滋病毒阳性者（接受治疗和未接受治疗）与艾滋病毒阴性对照者。
我们在南非约翰内斯堡进行了一项横断面研究。我们从三项随机对照试验中招募了艾滋病毒阳性参与者，这些试验从常规艾滋病毒检测项目中招募了参与者。艾滋病毒阴性对照者从社区招募。收集了人口统计学、心血管危险因素、病史以及心电图和超声心动图特征的数据。
总共招募了394名艾滋病毒阳性参与者和153名对照者。艾滋病毒阳性参与者的平均年龄为40±9岁（对照者：35±10岁），34%为男性（对照者：50%）。艾滋病毒阳性参与者中36%超重或肥胖（对照者：44%），23%患有高血压（对照者：28%），12%为当前吸烟者（对照者：37%）。自艾滋病毒诊断以来的中位时间为6.0年（四分位间距2.3 - 10.0），中位治疗持续时间为4.0年（四分位间距0.0 - 8.0），50%的人病毒载量不可检测。心脏解剖异常的发生率较低，艾滋病毒阳性者和阴性者之间无差异。我们未观察到艾滋病毒或抗逆转录病毒疗法（ART）与心脏收缩或舒张功能之间存在关联。ART的使用与校正QT间期之间存在关联：与艾滋病毒阴性对照者相比增加了11.8毫秒（p<0.01），与未接受ART治疗的参与者相比增加了18.9毫秒（p = 0.01）。我们还观察到接受ART治疗的参与者左心室质量指数较高（增加7.8克/平方米，p<0.01），但在调整CD4细胞计数、病毒载量和艾滋病毒感染持续时间后，这种关联消失。
在这个相对年轻、管理良好的非洲城市艾滋病毒阳性人群中，主要心脏异常数量较少，这令人安心。校正QT间期和左心室质量的增加可能会导致艾滋病毒感染者长期心脏死亡率和发病率升高。
