JACC: Heart Failure
Cardiac Dysfunction Among People Living With HIVA Systematic Review and Meta-Analysis
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Author + information
- Sebhat Erqou, MD, PhDa,b,∗∗ (sebhaterqou{at}gmail.com),
- Bereket Tessema Lodebo, MD, MPHc,∗,
- Ahmad Masri, MDd@MasriAhmadMD,
- Ahmed M. Altibi, MDd,
- Justin B. Echouffo-Tcheugui, MD, PhDe,
- Anastase Dzudie, MDf,
- Feven Ataklte, MD, MPhilg,
- Gaurav Choudhary, MDa,b@GChoudharyMD,
- Gerald S. Bloomfield, MD, MPHh,
- Wen-Chih Wu, MD, MPHa,b and
- Andre Pascal Kengnei
- aDepartment of Medicine, Providence VA Medical Center, Providence, Rhode Island
- bDepartment of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island
- cDepartment of Medicine, Harbor-UCLA Medical Center, Los Angeles, California
- dDepartment of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
- eDepartment of Medicine, Johns Hopkins University, Baltimore, Maryland
- fFaculty of Medicine and Biomedical Sciences, University of Yaounde, Yaounde, Cameroon
- gDepartment of Medicine, Boston University, Boston, Massachusetts
- hDuke Clinical Research Institute, Duke Global Health Institute and Department of Medicine, Duke University, Durham, North Carolina
- iSouth African Medical Research Council and University of Cape Town, South Africa
- ↵∗Address for correspondence:
Dr. Sebhat Erqou, Providence VA Medical Center, 830 Chalkstone Street, Providence, Rhode Island 02908.
Graphical abstract
Abstract
Objective To synthesize existing epidemiological data on cardiac dysfunction in HIV.
Background Data on the burden and risk of human immunodeficiency virus (HIV) infection-associated cardiac dysfunction have not been adequately synthesized. We performed meta-analyses of extant literature on the frequency of several subtypes of cardiac dysfunction among people living with HIV.
Methods We searched electronic databases and reference lists of review articles and combined the study-specific estimates using random-effects model meta-analyses. Heterogeneity was explored using subgroup analyses and meta-regressions.
Results We included 63 reports from 54 studies comprising up to 125,382 adults with HIV infection and 12,655 cases of various cardiac dysfunctions. The pooled prevalence (95% confidence interval) was 12.3% (6.4% to 19.7%; 26 studies) for left ventricular systolic dysfunction (LVSD); 12.0% (7.6% to 17.2%; 17 studies) for dilated cardiomyopathy; 29.3% (22.6% to 36.5%; 20 studies) for grades I to III diastolic dysfunction; and 11.7% (8.5% to 15.3%; 11 studies) for grades II to III diastolic dysfunction. The pooled incidence and prevalence of clinical heart failure were 0.9 per 100 person-years (0.4 to 2.1 per 100 person-years; 4 studies) and 6.5% (4.4% to 9.6%; 8 studies), respectively. The combined prevalence of pulmonary hypertension and right ventricular dysfunction were 11.5% (5.5% to 19.2%; 14 studies) and 8.0% (5.2% to 11.2%; 10 studies), respectively. Significant heterogeneity was observed across studies for all the outcomes analyzed (I2 > 70%, p < 0.01), only partly explained by available study level characteristics. There was a trend for lower prevalence of LVSD in studies reporting higher antiretroviral therapy use or lower proportion of acquired immune deficiency syndrome. The prevalence of LVSD was higher in the African region. After taking into account the effect of regional variation, there was evidence of lower prevalence of LVSD in studies published more recently.
Conclusions Cardiac dysfunction is frequent in people living with HIV. Additional prospective studies are needed to better understand the burden and risk of various forms of cardiac dysfunction related to HIV and the associated mechanisms. (Cardiac dysfunction in people living with HIV–a systematic review and meta-analysis; CRD42018095374)
Footnotes
↵∗ Drs. Erqou and Lodebo contributed equally to this work and are joint first authors.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received August 11, 2018.
- Revision received September 26, 2018.
- Accepted October 4, 2018.
- 2019 American College of Cardiology Foundation
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