Cardiology Section, San Francisco Veterans Affairs Health Care System, San Francisco, California, USA.
Department of Medicine, University of California San Francisco, San Francisco, California, USA.
Clin Infect Dis. 2023 Jan 13;76(2):210-219. doi: 10.1093/cid/ciac795.
People with human immunodeficiency virus (HIV) have been reported to have increased risk of clinical and subclinical cardiovascular disease. Existing studies have focused on men and often have been uncontrolled or lacked adequate HIV-negative comparators.
We performed echocardiography in the Women's Interagency HIV Study to investigate associations of HIV and HIV-specific factors with cardiac phenotypes, including left ventricular systolic dysfunction (LVSD), isolated LV diastolic dysfunction (LVDD), left atrial enlargement (LAE), LV hypertrophy (LVH), and increased tricuspid regurgitation velocity (TRV).
Of 1654 participants (age 51 ± 9 years), 70% had HIV. Sixty-three (5.4%) women with HIV (WWH) had LVSD; 71 (6.5%) had isolated LVDD. Compared with women without HIV (WWOH), WWH had a near-significantly increased risk of LVSD (adjusted relative risk = 1.69; 95% confidence interval = 1.00 to 2.86; P = .051). No significant association was noted for HIV seropositivity with other phenotypes, but there was a risk gradient for decreasing CD4+ count among WWH that approached or reached significance for isolated LVDD, LAE, and LVH. WWH with CD4+ count <200 cells/mm3 had significantly higher prevalence of LAE, LVH, and high TRV than WWOH. There were no consistent associations for viral suppression or antiretroviral drug exposure.
This study suggests that WWH have a higher risk of LVSD compared with sociodemographically similar WWOH, but their risk for isolated LVDD, LAE, LVH, and high TRV is increased only with reduced CD4+ count. Although these findings warrant replication, they support the importance of cardiovascular risk-factor and HIV-disease control for heart disease prevention in this population.
已有研究报告称，人类免疫缺陷病毒（HIV）感染者发生临床和亚临床心血管疾病的风险增加。现有研究主要集中在男性，且往往不受控制或缺乏足够的 HIV 阴性对照。
我们在妇女艾滋病病毒研究机构间合作中进行了超声心动图检查，以研究 HIV 及 HIV 特异性因素与心脏表型的关联，包括左心室收缩功能障碍（LVSD）、孤立性左心室舒张功能障碍（LVDD）、左心房扩大（LAE）、左心室肥厚（LVH）和三尖瓣反流速度增加（TRV）。
在 1654 名参与者（年龄 51 ± 9 岁）中，70%有 HIV。70 名（5.4%）HIV 阳性女性（WWH）有 LVSD；71 名（6.5%）有孤立性 LVDD。与无 HIV 的女性（WWOH）相比，WHW 发生 LVSD 的风险显著增加（调整后的相对风险=1.69；95%置信区间为 1.00 至 2.86；P=0.051）。但未发现 HIV 阳性与其他表型之间存在显著关联，然而，WHW 的 CD4+计数下降与孤立性 LVDD、LAE 和 LVH 呈风险梯度关系，接近或达到显著水平。CD4+计数<200 个细胞/mm3的 WWH 发生 LAE、LVH 和高 TRV 的比例明显高于 WWOH。病毒抑制或抗逆转录病毒药物暴露与这些结果没有一致关联。
本研究表明，与社会人口统计学相似的 WWOH 相比，WHW 发生 LVSD 的风险更高，但只有在 CD4+计数下降时，才会增加发生孤立性 LVDD、LAE、LVH 和高 TRV 的风险。虽然这些发现需要进一步证实，但它们支持对心血管危险因素和 HIV 疾病的控制，以预防该人群的心脏病。
