Abstract

Background

There are limited data on structural heart disease among people living with HIV in southern Africa, where the success of antiretroviral therapy (ART) has drastically improved life expectancy and where risk factors for cardiovascular disease are prevalent.

Methods

We performed a cross-sectional study of screening echocardiography among adults (≥18 years) with HIV in Malawi presenting for routine ART care. We used univariable and multivariable logistic regression to evaluate correlates of abnormal echocardiogram.

Results

A total of 202 individuals were enrolled with a median age of 45 years (IQR 39–52); 52% were female, and 27.7% were on antihypertensive medication. The most common clinically significant abnormality was left ventricular hypertrophy (LVH) (12.9%, n=26), and other serious structural heart lesions were rare (<2% with ejection fraction less than 40%, moderate-severe valve lesions or moderate-severe pericardial effusion). Characteristics associated with abnormal echocardiogram included older age (OR 1.04, 95% CI 1.01 to 1.08), higher body mass index (OR 1.09, 95% CI 1.02 to 1.17), higher mean systolic blood pressure (OR 1.03, 95% CI 1.02 to 1.05) and higher mean diastolic blood pressure (OR 1.03, 95% CI 1.01 to 1.05). In a multivariable model including age, duration on ART, body mass index, and systolic and diastolic blood pressure, only mean body mass index (adjusted OR 1.10, 95% CI 1.02 to 1.19), systolic blood pressure (aOR 1.05, 95% CI 1.03 to 1.08) and diastolic blood pressure (aOR 0.96, 95% CI 0.92 to 1.00) remained associated with abnormal echocardiogram.

Conclusions

LVH was common in this population of adults on ART presenting for routine care and was associated with elevated blood pressure. Further research is needed to characterise the relationship between chronic hypertension, LVH and downstream consequences, such as diastolic dysfunction and heart failure in people living with HIV.

Details

Title
High rate of left ventricular hypertrophy on screening echocardiography among adults living with HIV in Malawi
Author
Hoffman, Risa M 1   VIAFID ORCID Logo  ; Chibwana, Florence 2 ; Banda, Ben Allan 2 ; Kahn, Daniel 3 ; Gama, Khumbo 2 ; Boas, Zachary P 4 ; Chimombo, Mayamiko 2 ; Kussen, Chiulemu 5 ; Currier, Judith S 1 ; Namarika, Dan 6 ; Joep van Oosterhout 7 ; Phiri, Sam 2 ; Moses, Agnes 2 ; Currier, Jesse W 8 ; Sigauke, Hitler 2 ; Moucheraud, Corrina 9   VIAFID ORCID Logo  ; Canan, Tim 10 

1  Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at the University of California, Los Angeles, California, USA 
2  Partners in Hope, Lilongwe, Malawi 
3  Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA 
4  Department of Cardiology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California, USA 
5  Domasi Rural Hospital, Zomba, Malawi 
6  Malawi Ministry of Health, Lilongwe, Malawi 
7  Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at the University of California, Los Angeles, California, USA; Partners in Hope, Lilongwe, Malawi 
8  VA West Los Angeles Medical Center, Los Angeles, California, USA 
9  Department of Health Policy and Management, Jonathan and Karin Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, USA 
10  Department of Medicine, Division of Cardiology, David Geffen School of Medicine at the University of California, Los Angeles, California, USA 
First page
e002026
Section
Health care delivery, economics and global health care
Publication year
2022
Publication date
2022
Publisher
BMJ Publishing Group LTD
ISSN
2398595X
e-ISSN
20533624
Source type
Scholarly Journal
Language of publication
English
DOI
https://doi.org/10.1136/openhrt-2022-002026
ProQuest document ID
2674631461
Copyright
© 2022 Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:  http://creativecommons.org/licenses/by-nc/4.0/ . Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.