Subclinical Myocardial Fibrosis in South African Youth With HIV: Results From the CTAAC-Heart Study

Jennifer Jao; Heather J Zar; Morné Kahts; Stephen Jermy; Daniel Egan; Mothabisi N Nyathi; Nana Akua Asafu-Agyei; Justine Legbedze; Emma Carkeek; Nomawethu Jele; Tafadzwa Mautsa; Lauren Balmert Bonner; Grace A McComsey; Matthew Feinstein; Irwin J Kurland; Landon Myer; Ntobeko A B Ntusi

doi:10.1093/ofid/ofae555

Subclinical Myocardial Fibrosis in South African Youth With HIV: Results From the CTAAC-Heart Study

Open Forum Infect Dis. 2024 Oct 1;11(10):ofae555. doi: 10.1093/ofid/ofae555. eCollection 2024 Oct.

Authors

Jennifer Jao¹, Heather J Zar², Morné Kahts^{3

4}, Stephen Jermy^{4

5}, Daniel Egan^{3

4}, Mothabisi N Nyathi⁶, Nana Akua Asafu-Agyei², Justine Legbedze⁷, Emma Carkeek², Nomawethu Jele², Tafadzwa Mautsa², Lauren Balmert Bonner⁸, Grace A McComsey⁹, Matthew Feinstein^{8

10}, Irwin J Kurland¹¹, Landon Myer⁶, Ntobeko A B Ntusi^{3

4

12}

Affiliations

¹ Division of Pediatric Infectious Diseases, Division of Adult Infectious Diseases, Department of Pediatrics, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
² Department of Pediatrics and Child Health and SA-MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa.
³ Division of Cardiology, Department of Medicine, University of Cape Town, Cape Town, South Africa.
⁴ University of Cape Town/South African Medical Research Council Extramural Unit on Intersection of Noncommunicable Diseases With Infectious Diseases.
⁵ Division of Biomedical Engineering, Department of Human Biology, University of Cape Town, Cape Town, South Africa.
⁶ Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa.
⁷ Division of Pediatric Infectious Diseases, Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.
⁸ Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
⁹ Department of Medicine, Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio, USA.
¹⁰ Division of Adult Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
¹¹ Division of Adult Endocrinology, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA.
¹² African Research Universities Alliance/The Guild of European Research-Intensive Universities Cluster of Research Excellence on Noncommunicable Diseases and Associated Multimorbidity.

Abstract

Background: Few data exist on myocardial fibrosis and inflammation in youth with HIV.

Methods: We performed cardiovascular magnetic resonance (CMR) on a cross section of South African youth: youth with perinatally acquired HIV (YPHIV) undergoing antiretroviral therapy (ART), youth with nonperinatally acquired HIV (YNPHIV) receiving ART, and youth without HIV. Quantile regression models were fit to assess the association between HIV status and CMR outcomes: subclinical fibrosis (late gadolinium enhancement [LGE] mass and fraction, native T1, extracellular volume) and inflammation (native T1, T2 mapping).

Results: Of 464 youth, 287 were YPHIV, 87 were YNPHIV, and 90 were HIV seronegative. The median age was 16 years (range, 11-24). LGE mass was higher in YPHIV and YNPHIV than in youth who were HIV seronegative (1.85 vs 2.00 vs 1.41 g, respectively), as was fraction (5.8% vs 6.4% vs 4.5%); native T1 was highest in YNPHIV. In adjusted analyses, when compared with youth with HIV seronegativity, YPHIV and YNPHIV exhibited higher LGE mass (β = 0.468, P = .001; β = 0.544, P = .002) and LGE fraction (β = 1.587, P < .001; β = 1.781, P < .001). CMR outcomes were similar between YPHIV and YNPHIV.

Conclusions: Despite ART use, YPHIV and YNPHIV appear to have higher subclinical myocardial fibrosis than youth who are HIV seronegative and healthy adults in South Africa and may benefit from early screening/monitoring for cardiovascular disease.

Keywords: antiretroviral; myocardial fibrosis; myocardial magnetic resonance imaging; perinatally acquired HIV; youth with HIV.

Abstract

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