Systemic inflammation, myocardial fibrosis, and subclinical cardiovascular disease in people living with HIV

BACKGROUND: People living with HIV experience accelerated aging, increasing their risk of age-related diseases. Chronic inflammation may play an important role in premature vascular aging and myocardial fibrosis, leading to cardiac dysfunction. METHODS: We conducted a cross-sectional pilot study of matched veterans with and without HIV receiving care at the Providence VA Medical Center to explore the relationship between systemic inflammation, myocardial fibrosis, and subclinical cardiac disease in HIV. Participants were extensively phenotyped with questionnaires, physical exam, stress test, echocardiogram, cardiac MRI, coronary calcium score, and blood measurement of markers of inflammation and fibrosis. Multivariable linear regressions were used to investigate the associations. RESULTS: 21 veterans with HIV (mean age 54 years; 71% White, 29% Black) and 20 controls (mean age 56 years; 70% White, 30% Black) were included. We found higher growth differentiation factor (GDF)-15 blood levels, increased extracellular volume, and lower right heart function on MRI among patients with HIV, suggesting the presence of increased myocardial fibrosis and subclinical myocardial dysfunction in this population. CONCLUSION: Limited data from this pilot study suggest that HIV may be associated with increased cardiac fibrosis and decreased right ventricular function. This study highlights the need for larger longitudinal studies to better understand the trajectory of HIV-associated cardiac changes and help improve cardiac disease prevention in this population.