Please login or register to print this page.

ARTICLE CONTRIBUTORS

European Society of Cardiology

Clinical Articles, News & Views

Blood viral load nearly doubles heart disease prevalence

The role of HIV in causing structural heart disease supports introducing cardiovascular screening in all HIV patients, particularly those with a positive blood viral load, according to research presented by Dr Nieves Montoro (Madrid, Spain) at EuroEcho-Imaging 2013, held recently in Istanbul, Turkey.

The prospective cohort study included 65 HIV patients (63% male, average age 48 years) who had dyspnoea (shortness of breath) graded as >II on the NYHA scale.1 The stage of HIV was determined by measuring the CD4 count and their opportunistic diseases. Also, the viral blood load was determined. Patients had a transthoracic echocardiogram to assess whether they had structural heart disease (ventricular hypertrophy, systolic or diastolic dysfunction, or pulmonary hypertension). The following cardiovascular risk factors were assessed: hypertension, diabetes, smoking status, dyslipidemia and renal failure.

Nearly half of patients (47%) had some form of structural heart disease, mainly left ventricular hypertrophy, left ventricular dysfunction, pulmonary hypertension and signs of right ventricle failure (see figure). Patients with a positive blood viral load had a significantly higher incidence of structural heart disease than those with an undetectable load.

Dr Montoro said: “It is well known that patients with HIV have a high incidence of structural heart disease (mainly diastolic dysfunction and pulmonary hypertension) as measured by echocardiography but the reason is not clear. We decided to conduct a study to evaluate whether the stage of HIV or the detectable blood viral load were related to the degree of heart disease.”

“We found that half of HIV patients with dyspnoea had echocardiographic evidence of structural heart disease. Our most interesting finding was that patients with a positive blood viral load had a significantly higher incidence of structural heart disease. In fact, having a detectable blood viral load nearly doubled the prevalence of heart disease, suggesting that HIV itself might be an independent causal agent,” she added.

The amount of structural heart disease was not affected by whether or not the patient had AIDS, their gender, age, or presence of cardiovascular risk factors, although this is still a preliminary result and will have to be confirmed in further analysis, the authors found.

Dr Montoro said: “Our study shows an association between the presence of the virus in the blood and cardiac disease. These findings open the door to the hypothesis that HIV is involved in the aetiology of cardiac damage. It is known that HIV can produce a pro-inflammatory response and this could involve the heart too. We are conducting further studies to test this idea.”

She added: “One of the main objectives in HIV treatment is that blood virus levels are undetectable. When it is not achieved, the treatment is usually changed. Our findings show that having any detectable level of virus in the blood nearly doubles the risk of heart disease.”

Dr Montoro continued: “Because of the high incidence of cardiac problems in our study (almost 50%) we think that all HIV patients with dyspnoea should undergo a transthoracic echocardiogram to check for structural heart disease. This is a non-invasive, cost-effective and accessible diagnostic test. Furthermore, patients with a positive blood viral load are at nearly twice the risk of structural heart disease and they should receive an echocardiogram whether they are symptomatic or not.”

“Detecting cardiac problems in HIV patients sooner using a simple diagnostic tool like echocardiography will enable us to treat them in the very early stage of the heart damage and improve their prognosis. Patients found to have a detectable blood viral load and/or structural heart disease should have closer follow up by a cardiologist and their HIV specialist doctor,” she concluded.

Published on: December 20, 2013

Members Area

Log in or Register now.

SEARCH THE SITE

RSS FEED

Subscribe to our RSS feed
home

GET EXCLUSIVE UPDATES

Sign up for our regular email newsletters & be the first to know about fresh articles and site updates.

RECENT COMMENTS

    None Found

ENDORSED BY

  • ArrhythmiaAlliance
  • Stars
  • Anticoagulation Europe
  • Atrial Fibrillation Association
 

You are not logged in

You need to be a member to print this page.
Sign up for free membership, or log in.

You are not logged in

You need to be a member to download PDF's.
Sign up for free membership, or log in.