Abstract P327: Inflammation Associates With Lower Myocardial Function Among Antiretroviral-Treated Persons Living With HIV in South Africa

Abstract

Introduction: HIV-associated inflammation contributes to higher CVD risk among persons living with HIV (PLWH). Heart failure (HF) is a prominent CVD manifestation in sub-Saharan Africa where HIV prevalence is high. Systolic dysfunction is a well-known complication of untreated, advanced HIV disease, but it is unknown if ongoing inflammation contributes to myocardial dysfunction during antiretroviral therapy (ART). We evaluated myocardial function via cardiac magnetic resonance (CMR) and studied associations with inflammatory biomarkers among ART-treated PLWH residing in Khayelitsha township near Cape Town, South Africa. Methods: CMR images were ascertained via a large bore 3T Siemens Skyra MRI scanner using standardized protocols. Biomarkers were measured from stored plasma using immunoassays and were log 2 -transformed for analyses. Linear regression was used to evaluate cross-sectional associations between CMR parameters and biomarker concentrations, adjusted for age, sex, current smoking, and hypertension. Results: Among 133 ART-treated PLWH without known CVD, 64% (85) were female, 99% (132) were Black African, 29% (39) were smokers, 92% (123) had undetectable HIV viral load, mean (SD) age was 50 (9) years, and current and nadir CD4+ count were 535 (270) and 271 (213) cells/μL, respectively. Higher TNFR1, TNF-α, and IFN-γ were associated with lower left ventricular ejection fraction (p=0.03, 0.05, and 0.03, respectively) and systolic global circumferential strain (p=0.01, 0.04, and 0.02) ( Table ). Higher TNFR1 was also associated with lower diastolic strain rate in circumferential (p=0.02), longitudinal (p=0.05), and radial (p=0.01) planes. Conclusion: These data suggest inflammation may contribute to lower myocardial function among ART-treated PLWH prior to development of clinical HF. The magnitude of this effect was modest, but potential long-term effects on myocardial tissue remodeling and subsequent HF risk warrant further investigation among a growing ART-treated population in South Africa.