Abstract:

Objective: To compare the prevalence and predictors of myocardial dysfunction in HIV-infected and HIV-negative Tanzanian adults.

Methods: A cross-sectional study including 256 HIV-infected, ART-naïve and 263 HIV-negative Tanzanian adults. Traditional cardiovascular risk factors for myocardial dysfunction (age, sex, hypertension, body mass index, abdominal obesity and tobacco use) were determined by standard investigations. Bedside echocardiography was performed at time of enrollment. The primary outcome was echocardiographic prevalence of myocardial systolic and/or diastolic dysfunction as classified by the American Society of Echocardiography/European Association of Echocardiography guidelines.

Results: The average age of HIV-negative and HIV-infected participants was similar (36.8 vs 36.6 years). No study participants met criteria for systolic dysfunction. Compared with HIV-negative controls, more HIV-infected adults were classified as diastolic dysfunction (OR[CI]: 2.47[1.61-3.80], [78/256 (30.7%) vs 40/263 (15.2%)], p<0.0001, respectively), with HIV-infected adults also classified as Grade II/III more commonly than those HIV-negative (p=0.04). Diastolic dysfunction was significantly associated with hypertension, age and diastolic and systolic blood pressure in both HIV-infected and HIV-negative participants (3.26[1.56-6.81] and 5.67[2.68-11.99], 1.13[1.08-1.17] and 1.11[1.07-1.15], 1.03[1.01-1.06] and 1.09[1.06-1.13], 1.02[1.01-1.04] and 1.05[1.02-1.07], respectively). CD4 count was also associated with diastolic dysfunction in HIV-infected participants (0.998[0.997-0.999]). Additionally, HIV-infected participants required fewer traditional risk factors for dysfunction prevalence Probability of disease with one or fewer risk factors present was greater in HIV-infected as compared to HIV-negative adults (p=0.02).

Conclusions: HIV-infected Tanzanian adults have a higher prevalence of myocardial diastolic dysfunction and have more advanced disease as compared to HIV-negative controls. This dysfunction is present at a much younger age and with fewer traditional risk factors than previously reported HIV-negative populations. The most significant predictor for diastolic dysfunction is hypertension; therefore, echocardiography may be indicated for hypertensive, HIV-infected adults, independent of age.