The association between current CD4 counts and subclinical myocardial injury by cardiac magnetic resonance in HIV: independence from cardiovascular risk factors.

OBJECTIVES

To evaluate the association between immune status and subclinical myocardial injury by cardiovascular magnetic resonance (CMR) in people with HIV (PWH), independent of traditional cardiovascular risk factors.

DESIGN

This prospective study enrolled 98 PWH without known cardiovascular disease (CVD) and 91 Framingham Risk Score (FRS)-matched non-HIV controls.

METHODS

Myocardial function and tissue characteristics were assessed by CMR, including native T1/T2 mapping, extracellular volume fraction (ECV), and late gadolinium enhancement (LGE). Immunologic and treatment-related variables included duration of HIV infection, duration of ART, HIV viral load, current and nadir CD4 + and CD8 + T-cell counts, and CD4/CD8 ratio. Linear and logistic regression analyses adjusted for FRS and heart rate evaluated associations between immunologic parameters and CMR findings.

RESULTS

PWH demonstrated elevated global native T1, T2, ECV, and LGE, with reduced global longitudinal strain (GLS) and global circumferential strain (GCS) compared with non-HIV controls (all P  < 0.05). In multivariate analysis, current CD4 + T-cell counts correlated negatively with global native T1 ( β  = -0.361, P  < 0.001) and ECV ( β  = -0.318, P  = 0.001). Current CD4 + cell count <200 cells/μl was independently associated with elevated native T1 [odds ratio (OR), 7.199; 95% confidence interval (CI), 1.373-37.746; P  = 0.020] and elevated ECV (OR, 5.152; 95% CI, 1.260-21.062; P  = 0.023).

CONCLUSION

PWH exhibit subclinical myocardial fibrosis and dysfunction despite similar FRS to non-HIV controls. Current CD4 + T-cell counts <200 cells/μl are an independent predictor of subclinical myocardial injury.