Echocardiographic Assessment of US Air Force Members with Early HIV Infection

Abstract

Background HIV-infected individuals are at increased risk for cardiovascular disease (CVD) compared with HIV-uninfected persons. CVD studies are typically conducted years after HIV diagnosis, however the impact of uncontrolled HIV replication and immune activation on cardiovascular health during early HIV infection has not been adequately studied.Methods All US Air Force members with HIV infection receive comprehensive medical evaluations to include cardiovascular assessment by screening transthoracic echocardiography (TTE). This retrospective study analyzed demographic, CVD, and HIV disease characteristics in all newly diagnosed USAF members evaluated between September 1, 2015 and September 30, 2016. TTE studies were analyzed by a board certified Cardiologist and subgroup analyses were conducted by chi-square tests.ResultsPatients (n = 50) were predominantly male (96%), most commonly black race (60%), with a mean age of 28 years. Ten (20%) patients were active smokers and 2 (4%) had hypertension. The mean time from estimated date of HIV seroconversion to initial cardiac evaluation was 304 days. The mean CD4 count was 551 cells/uL and 2 (4%) patients were diagnosed with AIDS by CD4 criteria. The mean VL was 112,585 copies/mL and 15 (30%) had a VL >100,000 copies/mL. All patients had normal cardiovascular function as determined by ejection fraction (EF) and global longitudinal strain (GLS). Evidence of right ventricular dilation and cardiac remodeling was observed in 7 (14%) and 13 (26%) patients, respectively. Grade 2 diastolic dysfunction was observed in a single patient who had a VL >10 million copies/mL and CVD risk factors including age >50 years and active smoking. Subgroup analyses showed no significant differences in TTE results by CD4 cell count, VL, duration of HIV infection or traditional CVD risk factors (p >0.05 for all).Conclusion Although no cases of GLS or reduced EF were observed, a small proportion exhibited other TTE abnormalities during early HIV infection. These data suggest that untreated viral replication may have a low impact on CVD development early in the course of HIV infection. Longitudinal studies are warranted to determine the optimal timing of cardiac assessments to proactively identify CVD in HIV-infected persons.Disclosures All authors: No reported disclosures.