Myocardial Fibrosis among Antiretroviral Therapy-Treated Persons with Human Immunodeficiency Virus in South Africa

Scott R. Shuldiner; Lye Yeng Wong; Tess E. Peterson; Julian Wolfson; S. Jermy; H. Saad; Mbalabu A.J. Lumbamba; A. Singh; M. Shey; G. Meintjes; N. Ntusi; M. Ntsekhe; J. V. Baker

doi:10.1093/ofid/ofaa600

Myocardial Fibrosis among Antiretroviral Therapy-Treated Persons with Human Immunodeficiency Virus in South Africa

Scott R. Shuldiner, Lye Yeng Wong, Tess E. Peterson, Julian Wolfson, S. Jermy, H. Saad, Mbalabu A.J. Lumbamba, A. Singh, M. Shey, G. Meintjes, N. Ntusi, M. Ntsekhe, J. V. Baker

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Abstract

Background: Heart failure is a prominent cardiovascular disease (CVD) manifestation in sub-Sarahan Africa. Myocardial fibrosis is a central feature of heart failure that we aimed to characterize among persons with human immunodeficiency virus (PWH) in South Africa. Methods: Cardiovascular magnetic resonance (CMR) imaging was performed among PWH with viral suppression and uninfected controls, both free of known CVD. Plasma levels of N-terminal pro B-type natriuretic peptide (NT-proBNP) were measured. Comparisons by human immunodeficiency virus (HIV) status were made using linear and logistic regression, adjusted for age, sex, and hypertension. Results: One hundred thirty-four PWH and 95 uninfected persons completed CMR imaging; age was 50 and 49 years, with 63% and 67% female, respectively. Compared with controls, PWH had greater myocardial fibrosis by extracellular volume fraction ([ECV] absolute difference, 1.2%; 95% confidence interval [CI], 0.1-2.3). In subgroup analyses, the effect of HIV status on ECV was more prominent among women. Women (vs controls) were also more likely to have elevated NT-proBNP levels (>125 pg/mL; odds ratio, 2.4; 95% CI, 1.0-6.0). Among all PWH, an elevated NT-proBNP level was associated with higher ECV (3.4% higher; 95% CI, 1.3-5.5). Conclusions: Human immunodeficiency virus disease may contribute to myocardial fibrosis, with an effect more prominent among women. Research is needed to understand heart failure risk among PWH within sub-Saharan Africa.

Original language	English (US)
Article number	ofaa600
Journal	Open Forum Infectious Diseases
Volume	8
Issue number	1
DOIs	https://doi.org/10.1093/ofid/ofaa600
State	Published - Jan 1 2021

Bibliographical note

Funding Information:
This study was funded by the National Heart Lung and Blood Institute, National Institutes of Health (R21 HL137435) and the American Heart Association (17IRG33350064). This work was also supported in part by the Doris Duke Charitable Foundation through a grant supporting the Doris Duke International Clinical Research Fellows Program at the University of Minnesota. G. M. was supported by the Wellcome Trust (098316, 214321/Z/18/Z, and 203135/Z/16/Z) and the South African Research Chairs Initiative of the Department of Science and Technology and National Research Foundation of South Africa (Grant Number 64787).

Publisher Copyright:
© 2020 The Author(s) 2020. Published by Oxford University Press on behalf of Infectious Diseases Society of America.

Keywords

HIV
South Africa
cardiovascular disease
myocardial fibrosis

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Shuldiner, S. R., Wong, L. Y., Peterson, T. E., Wolfson, J., Jermy, S., Saad, H., Lumbamba, M. A. J., Singh, A., Shey, M., Meintjes, G., Ntusi, N., Ntsekhe, M., & Baker, J. V. (2021). Myocardial Fibrosis among Antiretroviral Therapy-Treated Persons with Human Immunodeficiency Virus in South Africa. Open Forum Infectious Diseases, 8(1), Article ofaa600. https://doi.org/10.1093/ofid/ofaa600

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abstract = "Background: Heart failure is a prominent cardiovascular disease (CVD) manifestation in sub-Sarahan Africa. Myocardial fibrosis is a central feature of heart failure that we aimed to characterize among persons with human immunodeficiency virus (PWH) in South Africa. Methods: Cardiovascular magnetic resonance (CMR) imaging was performed among PWH with viral suppression and uninfected controls, both free of known CVD. Plasma levels of N-terminal pro B-type natriuretic peptide (NT-proBNP) were measured. Comparisons by human immunodeficiency virus (HIV) status were made using linear and logistic regression, adjusted for age, sex, and hypertension. Results: One hundred thirty-four PWH and 95 uninfected persons completed CMR imaging; age was 50 and 49 years, with 63% and 67% female, respectively. Compared with controls, PWH had greater myocardial fibrosis by extracellular volume fraction ([ECV] absolute difference, 1.2%; 95% confidence interval [CI], 0.1-2.3). In subgroup analyses, the effect of HIV status on ECV was more prominent among women. Women (vs controls) were also more likely to have elevated NT-proBNP levels (>125 pg/mL; odds ratio, 2.4; 95% CI, 1.0-6.0). Among all PWH, an elevated NT-proBNP level was associated with higher ECV (3.4% higher; 95% CI, 1.3-5.5). Conclusions: Human immunodeficiency virus disease may contribute to myocardial fibrosis, with an effect more prominent among women. Research is needed to understand heart failure risk among PWH within sub-Saharan Africa.",

keywords = "HIV, South Africa, cardiovascular disease, myocardial fibrosis",

author = "Shuldiner, {Scott R.} and Wong, {Lye Yeng} and Peterson, {Tess E.} and Julian Wolfson and S. Jermy and H. Saad and Lumbamba, {Mbalabu A.J.} and A. Singh and M. Shey and G. Meintjes and N. Ntusi and M. Ntsekhe and Baker, {J. V.}",

note = "Funding Information: This study was funded by the National Heart Lung and Blood Institute, National Institutes of Health (R21 HL137435) and the American Heart Association (17IRG33350064). This work was also supported in part by the Doris Duke Charitable Foundation through a grant supporting the Doris Duke International Clinical Research Fellows Program at the University of Minnesota. G. M. was supported by the Wellcome Trust (098316, 214321/Z/18/Z, and 203135/Z/16/Z) and the South African Research Chairs Initiative of the Department of Science and Technology and National Research Foundation of South Africa (Grant Number 64787). Publisher Copyright: {\textcopyright} 2020 The Author(s) 2020. Published by Oxford University Press on behalf of Infectious Diseases Society of America.",

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AU - Wong, Lye Yeng

AU - Peterson, Tess E.

AU - Wolfson, Julian

AU - Jermy, S.

AU - Saad, H.

AU - Lumbamba, Mbalabu A.J.

AU - Singh, A.

AU - Shey, M.

AU - Meintjes, G.

AU - Ntusi, N.

AU - Ntsekhe, M.

AU - Baker, J. V.

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N2 - Background: Heart failure is a prominent cardiovascular disease (CVD) manifestation in sub-Sarahan Africa. Myocardial fibrosis is a central feature of heart failure that we aimed to characterize among persons with human immunodeficiency virus (PWH) in South Africa. Methods: Cardiovascular magnetic resonance (CMR) imaging was performed among PWH with viral suppression and uninfected controls, both free of known CVD. Plasma levels of N-terminal pro B-type natriuretic peptide (NT-proBNP) were measured. Comparisons by human immunodeficiency virus (HIV) status were made using linear and logistic regression, adjusted for age, sex, and hypertension. Results: One hundred thirty-four PWH and 95 uninfected persons completed CMR imaging; age was 50 and 49 years, with 63% and 67% female, respectively. Compared with controls, PWH had greater myocardial fibrosis by extracellular volume fraction ([ECV] absolute difference, 1.2%; 95% confidence interval [CI], 0.1-2.3). In subgroup analyses, the effect of HIV status on ECV was more prominent among women. Women (vs controls) were also more likely to have elevated NT-proBNP levels (>125 pg/mL; odds ratio, 2.4; 95% CI, 1.0-6.0). Among all PWH, an elevated NT-proBNP level was associated with higher ECV (3.4% higher; 95% CI, 1.3-5.5). Conclusions: Human immunodeficiency virus disease may contribute to myocardial fibrosis, with an effect more prominent among women. Research is needed to understand heart failure risk among PWH within sub-Saharan Africa.

AB - Background: Heart failure is a prominent cardiovascular disease (CVD) manifestation in sub-Sarahan Africa. Myocardial fibrosis is a central feature of heart failure that we aimed to characterize among persons with human immunodeficiency virus (PWH) in South Africa. Methods: Cardiovascular magnetic resonance (CMR) imaging was performed among PWH with viral suppression and uninfected controls, both free of known CVD. Plasma levels of N-terminal pro B-type natriuretic peptide (NT-proBNP) were measured. Comparisons by human immunodeficiency virus (HIV) status were made using linear and logistic regression, adjusted for age, sex, and hypertension. Results: One hundred thirty-four PWH and 95 uninfected persons completed CMR imaging; age was 50 and 49 years, with 63% and 67% female, respectively. Compared with controls, PWH had greater myocardial fibrosis by extracellular volume fraction ([ECV] absolute difference, 1.2%; 95% confidence interval [CI], 0.1-2.3). In subgroup analyses, the effect of HIV status on ECV was more prominent among women. Women (vs controls) were also more likely to have elevated NT-proBNP levels (>125 pg/mL; odds ratio, 2.4; 95% CI, 1.0-6.0). Among all PWH, an elevated NT-proBNP level was associated with higher ECV (3.4% higher; 95% CI, 1.3-5.5). Conclusions: Human immunodeficiency virus disease may contribute to myocardial fibrosis, with an effect more prominent among women. Research is needed to understand heart failure risk among PWH within sub-Saharan Africa.

KW - HIV

KW - South Africa

KW - cardiovascular disease

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Myocardial Fibrosis among Antiretroviral Therapy-Treated Persons with Human Immunodeficiency Virus in South Africa

Abstract

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UN SDGs

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