Abstract 182: Left Ventricular Diastolic Dysfunction in HIV-infected ART-naive and HIV-negative Tanzanian Adults: A Cross-sectional Study

Abstract

Objective: To compare the prevalence and associated factors of left ventricular diastolic dysfunction in HIV-infected, ART naïve and HIV-negative Tanzanian adults. Methods: A cross-sectional analysis of a longitudinal study including: 257 HIV-infected, ART naïve adults and 265 HIV-negative controls. Echocardiography and traditional risk factors were performed and determined by standard investigations. The primary outcome was prevalence of left ventricular diastolic dysfunction. Secondary outcomes were factors associated with and grade of dysfunction. Results: Compared to HIV-negative controls, HIV-infected, ART naïve adults had a 2-fold higher prevalence of diastolic dysfunction (OR=2.06 [1.16-3.66], p=0.01). Additionally, age, female sex, obesity and hypertension were significantly associated with dysfunction in HIV-negative adults; whereas, only age and hypertension were associated with dysfunction in HIV-infected adults. As compared to HIV-negative controls, significantly more HIV-infected, ART naïve adults had higher grade dysfunction (p=0.02) and more ventricular hypertrophy. HIV-infected adults with diastolic dysfunction also expressed higher levels of inflammatory cytokines including TNFa, IL6, IL8, IL33 and sST2 as compared to both HIV-negative and HIV-infected adults without dysfunction. Conclusions: HIV-infected Tanzanian adults have a 2-fold higher prevalence of left ventricular diastolic dysfunction in the period immediately following diagnosis and before ART initiation as compared to HIV-negative adults, and this dysfunction is of higher grade and is associated with myocardial hypertrophy. These data identify diastolic dysfunction in an international cohort in the immediate post-diagnosis, pre-ART period similar to that previously reported in the post-ART period in high-income countries. Additionally, traditional cardiovascular risk factors are not significantly associated with dysfunction in HIV-infected adults; however, cytokine patterns are present and may be important for risk stratification in this group. Therefore, studies delineating appropriate screening for this population are needed.