title: High Prevalence of Echocardiographic Abnormalities among HIV-infected Persons in the Era of Highly Active Antiretroviral Therapy.
abstract: BACKGROUND
  in the era of highly active antiretroviral therapy (HAART), human immunodeficiency virus (HIV)-infected persons have higher cardiovascular disease risk. Little is known about asymptomatic abnormalities in cardiac structure and function in this population.
  
  
  METHODS
  the Study to Understand the Natural History of HIV/AIDS in the Era of Effective Therapy (SUN Study) is a prospective, observational, multi-site cohort of 656 HIV-infected participants who underwent baseline echocardiography during 2004-2006. We examined prevalence of and factors associated with left ventricular systolic dysfunction (LVSD), diastolic dysfunction (DD), pulmonary hypertension (PHTN), left ventricular hypertrophy (LVH), and left atrial enlargement (LAE).
  
  
  RESULTS
  participant characteristics were as follows: median age, 41 years; 24% women; 29% non-Hispanic black; 73% receiving HAART; and median CD4+ cell count, 462 cells/μL. Among evaluable participants, 18% had LVSD, 26% had DD, 57% had PHTN (right ventricular pressure >30 mm Hg), 6.5% had LVH, and 40% had LAE. In multivariate analyses, significant factors (P < .05) associated with LVSD were history of MI, elevated highly sensitive C-reactive protein (hsCRP) level, and current tobacco smoking; for DD, elevated hsCRP level and hypertension; for PHTN, current use of ritonavir; for LVH, hypertension, diabetes, non-white race, female sex with elevated body mass index, calculated as the weight in kilograms divided by the square of height in meters, of ≥ 25, elevated hsCRP level, and current use of abacavir; for LAE, hypertension and recent marijuana use.
  
  
  CONCLUSIONS
  in this large contemporary HIV cohort, the prevalence of subclinical functional and structural cardiac abnormalities was greater than expected for age. Abnormalities were mostly associated with expected and often modifiable risks. Lifestyle modification should become a greater priority in the management of chronic HIV disease.
authors.affiliation: Washington University School of Medicine, St Louis, Missouri, Central Texas Veterans HealthcareSystem, Austin, TX 78701, USA. kristinmd@swbell.net
authors.forename: Kristin E
authors.initials: KE
authors.lastname: Mondy
authors.forename: John
authors.initials: J
authors.lastname: Gottdiener
authors.forename: E Turner
authors.initials: ET
authors.lastname: Overton
authors.forename: Keith
authors.initials: K
authors.lastname: Henry
authors.forename: Tim
authors.initials: T
authors.lastname: Bush
authors.forename: Lois
authors.initials: L
authors.lastname: Conley
authors.forename: John
authors.initials: J
authors.lastname: Hammer
authors.forename: Charles C
authors.initials: CC
authors.lastname: Carpenter
authors.forename: Erna
authors.initials: E
authors.lastname: Kojic
authors.forename: Pragna
authors.initials: P
authors.lastname: Patel
authors.forename: John T
authors.initials: JT
authors.lastname: Brooks
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000473:pathology; D004452:Echocardiography; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors