Human immunodeficiency virus infection (HIV) has been associated with cardiac dysfunction that, if present, can negatively affect morbidity and mortality of HIV-infected patients. Unfortunately, many of the studies on this topic were performed before the highly active antiretroviral therapy (HAART) was established. Thus, we performed a comprehensive meta-analysis to critically appraise the incidence of cardiac dysfunction in HIV-infected pauci symptomatic patients.Medline, Cochrane Library, and Biomed Central were systematically screened for studies reporting on systolic and/or diastolic dysfunctions in HIV pauci-symptomatic patients. Baseline treatment and cardiac imaging data were appraised and pooled with random effect methods computing summary. At pooled analysis, including a total of 2242 patients from 11 studies, an overall average incidence of traditional cardiovascular risk factors was observed, while a low rate of previous coronary artery disease was reported. Incidence of systolic and diastolic left ventricular dysfunction was 8.33\% (95\% CI: 2.20-14.25) and 43.38\% (95\% CI: 31.73-55.03), respectively. Diastolic dysfunction was graded as first [31.85\% (95\% CI: 24.85-43.73)], second [8.53\% (95\% CI: 2.12-14.93)], and third degree [3.02\% (95\% CI: 1.78-4.27)]. At multivariate analysis, a high sensitivity C-reactive protein level >5 mg/L, active tobacco smoking and previous history of myocardial infarction were predictors of left ventricular systolic dysfunction [odd ratio 1.70 (95\% CI: 1.03-2.77); 1.57 (95\% CI: 1.03-2.34); and 15.90 (95\% CI: 1.94-329.00), respectively]. Hypertension (OR = 2.30; 95\% CI: 1.20-4.50) and older age (OR = 2.50 per 10 years increase; 95\% CI: 1.70-3.60) were predictors of left ventricular diastolic dysfunction (Figure  3).Systolic and diastolic dysfunction represent a common finding in pauci symptomatic HIV-infected patients, regardless to HAART.

Cardiac dysfunction in pauci symptomatic human immunodeficiency virus patients: a meta-analysis in the highly active antiretroviral therapy era

CERRATO, Enrico;D'ASCENZO, FABRIZIO;CALCAGNO, Andrea;CASTAGNO, Davide;QUADRI, Giorgio;PRESUTTI, DAVIDE GIACOMO;BONORA, Stefano;GAITA, Fiorenzo
2013

Abstract

Human immunodeficiency virus infection (HIV) has been associated with cardiac dysfunction that, if present, can negatively affect morbidity and mortality of HIV-infected patients. Unfortunately, many of the studies on this topic were performed before the highly active antiretroviral therapy (HAART) was established. Thus, we performed a comprehensive meta-analysis to critically appraise the incidence of cardiac dysfunction in HIV-infected pauci symptomatic patients.Medline, Cochrane Library, and Biomed Central were systematically screened for studies reporting on systolic and/or diastolic dysfunctions in HIV pauci-symptomatic patients. Baseline treatment and cardiac imaging data were appraised and pooled with random effect methods computing summary. At pooled analysis, including a total of 2242 patients from 11 studies, an overall average incidence of traditional cardiovascular risk factors was observed, while a low rate of previous coronary artery disease was reported. Incidence of systolic and diastolic left ventricular dysfunction was 8.33\% (95\% CI: 2.20-14.25) and 43.38\% (95\% CI: 31.73-55.03), respectively. Diastolic dysfunction was graded as first [31.85\% (95\% CI: 24.85-43.73)], second [8.53\% (95\% CI: 2.12-14.93)], and third degree [3.02\% (95\% CI: 1.78-4.27)]. At multivariate analysis, a high sensitivity C-reactive protein level >5 mg/L, active tobacco smoking and previous history of myocardial infarction were predictors of left ventricular systolic dysfunction [odd ratio 1.70 (95\% CI: 1.03-2.77); 1.57 (95\% CI: 1.03-2.34); and 15.90 (95\% CI: 1.94-329.00), respectively]. Hypertension (OR = 2.30; 95\% CI: 1.20-4.50) and older age (OR = 2.50 per 10 years increase; 95\% CI: 1.70-3.60) were predictors of left ventricular diastolic dysfunction (Figure  3).Systolic and diastolic dysfunction represent a common finding in pauci symptomatic HIV-infected patients, regardless to HAART.
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http://dx.doi.org/10.1093/eurheartj/ehs471
Adult, Antiretroviral Therapy; Highly Active, HIV Infections; drug therapy/physiopathology, Heart Diseases; physiopathology/virology, Humans, Middle Aged, Stroke Volume; physiology, Tomography; Emission-Computed; Single-Photon
Cerrato E;D'Ascenzo F;Biondi-Zoccai G;Calcagno A;Frea S;Grosso Marra W;Castagno D;Omedè P;Quadri G;Sciuto F;Presutti D;Frati G;Bonora S;Moretti C;Gaita F
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/2318/130319
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