Cardiovascular Effects of Antiretroviral Therapy in Human Immunodeficiency Virus Patients: A Strain Echocardiography Study

Abstract

Aim: The availability of antiretroviral treatments (ART) has transformed Human Immunodeficiency Virus (HIV) management, turning it from a fatal infection into a manageable chronic condition by effectively reducing viral replication and enhancing patient survival rates. Cardiovascular disease (CVD) is increasingly recognized as a leading cause of morbidity and death among people living with HIV, highlighting the need to monitor potential adverse effects of ART on the cardiovascular system. This study assessed the cardiovascular effects of ART in a cohort of HIV-infected patients by analyzing laboratory, echocardiographic strain, and demographic data before and after treatment. Material and Methods: A total of 56 patients who attended the infectious diseases clinic and were scheduled to receive ART treatment were included in the study. A comprehensive cardiovascular assessment, comprising anamnesis, electrocardiogram, and transthoracic strain echocardiography, was conducted before and three months after the initiation of ART therapy. Results: Examination of lipid parameter changes across treatment regimens revealed a statistically significant elevation in total cholesterol, low-density lipoprotein (LDL) cholesterol, and highdensity lipoprotein (HDL) cholesterol in the group treated with tenofovir alafenamide following treatment initiation. Regarding echocardiographic parameters evaluated post-treatment, there was no statistically significant change observed in left ventricular systolic function (LVEF) and diastolic function (septal E/e’ratio) (60.81±5.5 vs. 61.16±4.3, p=0.313, and 9.23±2.2 vs. 9.43±2.6, p=0.214, respectively). Notably, a significant improvement was observed in left ventricular global longitudinal strain (LV-GLS), with values changing from -18.74±2.9 to -19.75±2.4 (p<0.001). Conclusion: Our study demonstrates that ART can exert a beneficial influence on cardiovascular health by enhancing myocardial strain and diminishing inflammatory markers in patients infected with HIV.

Keywords

• Antiretroviral treatments
• Human Immunodeficiency Virus
• Strain echocardiography.

References

1. 1. UNAIDS. Global HIV & AIDS statistics -Fact sheet; 2022.
2. 2. Smith CJ, Ryom L, Weber R, Morlat P, Pradier C, Reiss P, et al. Trends in underlying causes of death in people with HIV from 1999 to 2011(D. A. D): a multicohort collaboration. Lancet. 2014;384(9939):241–248. https://doi.org/10.1016/S0140-6736(14)60604-8
3. 3. So-Armah K, Benjamin LA, Bloomfield GS, Feinstein MJ, Hsue P, Njuguna B, et al. HIV and cardiovascular disease. Lancet HIV. 2020;7(4):e279–e293. https://doi.org/10.1016/S2352- 3018(20)30036-9
4. 4. Shah ASV, Stelzle D, Lee KK, Beck EJ, Alam S, Clifford S, et al. Global burden of atherosclerotic cardiovascular disease in people living with HIV. Systematic review and metaanalysis. Circulation. 2018;138(11):1100–1112. https://doi.org/10.1161/CIRCULATIONAHA.117.033369
5. 5. Jain RG, Furfine ES, Pedneault L, White AJ, Lenhard JM. Metabolic complications associated with antiretroviral therapy. Antiviral Res. 2001;51(3):151–177. https://doi.org/10.1016/ S0166-3542(01)00148-6
6. 6. Parra-Rodriguez L, Sahrmann JM, Butler AM, Olsen MA, Powderly WG, O’Halloran JA. Antiretroviral therapy and cardiovascular risk in people with HIV in the United States: an updated analysis. Open Forum Infect Dis. 2024;11(9):ofae485. https://doi.org/10.1093/ofid/ofae485
7. 7. Hileman CO, Funderburg NT. Inflammation, immune activation, and antiretroviral therapy in HIV. Curr HIV/AIDS Rep. 2017;14(3):93–100. https://doi.org/10.1007/s11904-017-0356-x
8. 8. Savvoulidis P, Butler J, Kalogeropoulos A. Cardiomyopathy and heart failure in patients with HIV infection. Can J Cardiol. 2019;35(3):299–309. https://doi.org/10.1016/j.cjca.2018.10.009

9. 9. Hileman CO, Funderburg NT. Inflammation, immune activation, and antiretroviral therapy in HIV. Curr HIV/AIDS Rep. 2017;14(3):93–100. https://doi.org/10.1007/s11904-017-0356-x
10. 10. Barbaro G. Heart and HAART. Two sides of the coin for HIVassociated cardiology issues. World J Cardiol. 2010;2(3):53–57. https://doi.org/10.4330/wjc.v2.i3.53
11. 11. Tawakol A, Lo J, Zanni MV, Marmarelis E, Ihenachor EJ, MacNabb M, et al. Increased arterial inflammation relates to high-risk coronary plaque morphology in HIV-infected patients. J Acquir Immune Defic Syndr. 2014;66(2):164–171. https://doi.org/10.1097/QAI.0000000000000138
12. 12. Lo J, Lu MT, Ihenachor EJ, Wei J, Looby SE, Fitch KV, et al. Effects of statin therapy on coronary artery plaque volume and high-risk plaque morphology in HIV-infected patients. Lancet HIV. 2015;2(2):e52–e63. https://doi.org/10.1016/S2352-3018(14)00032-0
13. 13. Gambahaya ET, Rana R, Bagchi S, Sharma G, Sarkar S, Goerlich E, et al. The role of multimodality imaging in HIV-associated cardiomyopathy. Front Cardiovasc Med. 2022;8:811593. https://doi.org/10.3389/fcvm.2021.811593
14. 14. Kumar P, Arendt C, Martin S, Al Soufi S, DeLeuw P, Nagel E, et al. Multimodality imaging in HIV-associated cardiovascular complications: A comprehensive review. Int J Environ Res Public Health. 2023;20(3):2201. https://doi.org/10.3390/ijerph20032201
15. 15. Milei J, Grana D, Fernandez Alonso G, Matturri L. Cardiac involvement in acquired immunodeficiency syndrome: a review. Clin Cardiol. 1998;21:465–72. https://doi.org/10.1002/ clc.4960210704
16. 16. Ogunmodede JA, Kolo PM, Katibi IA, Salami AK, Omotoso A. Structural echocardiographic abnormalities seen in HIV/AIDS patients are independent of CD4 count. Niger J Clin Pract. 2017;20(6):716–23. https://doi.org/10.4103/1119-3077.208954
17. 17. Donati KdG, Cauda R, Iacoviello L. HIV infection, antiretroviral therapy, and cardiovascular risk. Medit J Hemat Infect Dis. 2010;2(3):e2010034. https://doi.org/10.4084/ mjhid.2010.034