Robbertse Pieter-Paul S, Steyn Jan, Rajah Megan R, Doubell Anton F, Nachega Jean B, Herbst Philip G
Division of Cardiology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, South Africa.
University of Pittsburgh HIV-Comorbidities Research Training Programme in South Africa.
SA Heart J. 2024 Apr 26;21(1):48-57. doi: 10.24170/21-1-6322.
Cardiovascular abnormalities are increasingly recognised among people newly diagnosed with HIV, but subclinical pathology may be challenging to diagnose. We present a case study of subtle cardiovascular changes in identical twins, one without HIV-infection and the other recently diagnosed with HIV (serodiscordant). We hypothesise that cardiovascular parameters would be similar between the twins, unless non-genetic (environmental) factors are at play. These differences likely represent occult pathology secondary to the effects of early HIV-infection. A 25-year-old female incidentally diagnosed with HIV, and her HIV-uninfected identical twin, living with her since birth, underwent comprehensive cardiovascular assessments. The HIV-positive twin exhibited a globular left ventricle (LV), larger LV volumes, decreased LV strain, peak atrial longitudinal strain (PALS) and higher native T1 and T2 mapping values compared to her sister. Cardiac biomarkers high sensitivity cardiac troponin T and N-terminal proBNP, as well as the novel markers of fibrosis and remodelling, galectin-3 and soluble-ST2, were higher in the HIV-infected twin. Given the twins' shared environment and genetic makeup, these differences likely stem from HIV-infection. Our study supports previous findings and suggests potential screening markers for HIV-associated cardiovascular disease, including PALS. Further research is warranted to explore PALS' utility in this context.
心血管异常在新诊断出感染艾滋病毒的人群中越来越受到重视，但亚临床病理可能难以诊断。我们介绍了一对同卵双胞胎的细微心血管变化的案例研究，其中一个未感染艾滋病毒，另一个最近被诊断出感染艾滋病毒（血清学不一致）。我们假设，除非非遗传（环境）因素起作用，否则双胞胎之间的心血管参数将相似。这些差异可能代表早期艾滋病毒感染影响所致的隐匿性病理。一名25岁偶然诊断出感染艾滋病毒的女性及其自出生以来一直与其生活在一起的未感染艾滋病毒的同卵双胞胎接受了全面的心血管评估。与她的妹妹相比，感染艾滋病毒的双胞胎表现出球形左心室（LV）、更大的左心室容积、左心室应变降低、心房纵向峰值应变（PALS）以及更高的固有T1和T2映射值。感染艾滋病毒的双胞胎的心脏生物标志物高敏心肌肌钙蛋白T和N末端脑钠肽前体，以及纤维化和重塑的新标志物半乳糖凝集素-3和可溶性ST2更高。鉴于双胞胎共享的环境和基因构成，这些差异可能源于艾滋病毒感染。我们的研究支持先前的发现，并提出了艾滋病毒相关心血管疾病的潜在筛查标志物，包括PALS。有必要进行进一步研究以探索PALS在此背景下的效用。
