HIV causes structural heart disease

Researchers from Spain have shown that HIV causes structural heart disease. These findings support the introduction of cardiovascular screening for all HIV patients, particularly those who have a positive viral load.

"It is well known that patients with HIV have a high incidence of structural heart disease (mainly diastolic dysfunction and pulmonary hypertension) as measured by echocardiography but the reason is not clear. We decided to conduct a study to evaluate whether the stage of HIV or the detectable blood viral load were related to the degree of heart disease."

The Centers for Disease Control and Prevention (CDC) estimates that there are 1,144,500 people aged over 13 living with HIV in the US.

For the study, researchers analyzed data from 65 HIV patients, with an average age of 48. All the participants reported shortness of breath - dyspnea - which was graded as greater than class II on the New York Heart Association (NYHA) scale.

According to the Heart Failure Society of America, the NYHA scale is used by physicians to determine the stage of heart failure in patients and focuses on the patient's symptoms in relation to their daily activities and quality of life.

It ranges from class I with mild symptoms through to IV, where symptoms are severe and patients are unable to perform any physical activity without discomfort. This study focuses on classes III and IV, where patients display moderate to severe symptoms.

Participants' HIV stage was determined by the CD4 (T-cells) count, their susceptibility to opportunistic diseases and their viral blood load, tested by determining the number of virus particles, or copies, within a milliliter of blood.
AIDs.gov explains that while there is no "normal" viral load, as people who are not infected have no viral load, it is considered "undetectable" if the test measures are less than 40-75 copies in 1 milliliter of blood.

Patients were also given a transthoracic echocardiogram to see if they had structural heart disease (ventricular hypertrophy, systolic or diastolic dysfunction or pulmonary hypertension). Cardiovascular risk factors, such as diabetes, hypertension, smoking status and renal failure, were also assessed.

The researchers found that almost half of the patients (47%) had some type of structural heart disease, usually left ventricular hypertrophy, left ventricular dysfunction, pulmonary hypertension and signs of right ventricle failure.