Cardiac Dysfunction Among People Living With HIV: A Systematic Review and Meta-Analysis

Sebhat Erqou, Bereket Tessema Lodebo, Ahmad Masri, Ahmed M. Altibi, Justin Echouffo Tcheugui, Anastase Dzudie, Feven Ataklte, Gaurav Choudhary, Gerald S. Bloomfield, Wen Chih Wu, Andre Pascal Kengne

Research output: Contribution to journalArticle

Abstract

Objective: To synthesize existing epidemiological data on cardiac dysfunction in HIV. Background: Data on the burden and risk of human immunodeficiency virus (HIV) infection-associated cardiac dysfunction have not been adequately synthesized. We performed meta-analyses of extant literature on the frequency of several subtypes cardiac dysfunction among people living with HIV. Methods: We searched electronic databases and reference lists of review articles and combined the study-specific estimates using random-effects model meta-analyses. Heterogeneity was explored using subgroup analyses and meta-regressions. Results: We included 63 reports from 54 studies comprising up to 125,382 adults with HIV infection and 12,655 cases of various cardiac dysfunctions. The pooled prevalence (95% confidence interval) was 12.3% (6.4% to 19.7%; 26 studies) for left ventricular systolic dysfunction (LVSD); 12.0% (7.6% to 17.2%; 17 studies) for dilated cardiomyopathy; 29.3% (22.6% to 36.5%; 20 studies) for grades I to III diastolic dysfunction; and 11.7% (8.5% to 15.3%; 11 studies) for grades II to III diastolic dysfunction. The pooled incidence and prevalence of clinical heart failure were 0.9 per 100 person-years (0.4 to 2.1 per 100 person-years; 4 studies) and 6.5% (4.4% to 9.6%; 8 studies), respectively. The combined prevalence of pulmonary hypertension and right ventricular dysfunction were 11.5% (5.5% to 19.2%; 14 studies) and 8.0% (5.2% to 11.2%; 10 studies), respectively. Significant heterogeneity was observed across studies for all the outcomes analyzed (I2 > 70%, p < 0.01), only partly explained by available study level characteristics. There was a trend for lower prevalence of LVSD in studies reporting higher antiretroviral therapy use or lower proportion of acquired immune deficiency syndrome. The prevalence of LVSD was higher in the African region. After taking into account the effect of regional variation, there was evidence of lower prevalence of LVSD in studies published more recently. Conclusions: Cardiac dysfunction is frequent in people living with HIV. Additional prospective studies are needed to better understand the burden and risk of various forms of cardiac dysfunction related to HIV and the associated mechanisms. (Cardiac dysfunction in people living with HIV–a systematic review and meta-analysis; CRD42018095374)

Original languageEnglish (US)
Pages (from-to)98-108
Number of pages11
JournalJACC: Heart Failure
Volume7
Issue number2
DOIs
StatePublished - Feb 1 2019

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Meta-Analysis
HIV
Left Ventricular Dysfunction
Virus Diseases
Right Ventricular Dysfunction
Dilated Cardiomyopathy
Pulmonary Hypertension
Acquired Immunodeficiency Syndrome
Heart Failure
Regression Analysis
Outcome Assessment (Health Care)
Databases
Prospective Studies
Confidence Intervals
Incidence
Therapeutics

Keywords

  • cardiac dysfunction
  • cardiomyopathy
  • HIV
  • human immunodeficiency virus
  • meta-analysis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Cardiac Dysfunction Among People Living With HIV : A Systematic Review and Meta-Analysis. / Erqou, Sebhat; Lodebo, Bereket Tessema; Masri, Ahmad; Altibi, Ahmed M.; Echouffo Tcheugui, Justin; Dzudie, Anastase; Ataklte, Feven; Choudhary, Gaurav; Bloomfield, Gerald S.; Wu, Wen Chih; Kengne, Andre Pascal.

In: JACC: Heart Failure, Vol. 7, No. 2, 01.02.2019, p. 98-108.

Research output: Contribution to journalArticle

Erqou, S, Lodebo, BT, Masri, A, Altibi, AM, Echouffo Tcheugui, J, Dzudie, A, Ataklte, F, Choudhary, G, Bloomfield, GS, Wu, WC & Kengne, AP 2019, 'Cardiac Dysfunction Among People Living With HIV: A Systematic Review and Meta-Analysis', JACC: Heart Failure, vol. 7, no. 2, pp. 98-108. https://doi.org/10.1016/j.jchf.2018.10.006
Erqou, Sebhat ; Lodebo, Bereket Tessema ; Masri, Ahmad ; Altibi, Ahmed M. ; Echouffo Tcheugui, Justin ; Dzudie, Anastase ; Ataklte, Feven ; Choudhary, Gaurav ; Bloomfield, Gerald S. ; Wu, Wen Chih ; Kengne, Andre Pascal. / Cardiac Dysfunction Among People Living With HIV : A Systematic Review and Meta-Analysis. In: JACC: Heart Failure. 2019 ; Vol. 7, No. 2. pp. 98-108.
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abstract = "Objective: To synthesize existing epidemiological data on cardiac dysfunction in HIV. Background: Data on the burden and risk of human immunodeficiency virus (HIV) infection-associated cardiac dysfunction have not been adequately synthesized. We performed meta-analyses of extant literature on the frequency of several subtypes cardiac dysfunction among people living with HIV. Methods: We searched electronic databases and reference lists of review articles and combined the study-specific estimates using random-effects model meta-analyses. Heterogeneity was explored using subgroup analyses and meta-regressions. Results: We included 63 reports from 54 studies comprising up to 125,382 adults with HIV infection and 12,655 cases of various cardiac dysfunctions. The pooled prevalence (95{\%} confidence interval) was 12.3{\%} (6.4{\%} to 19.7{\%}; 26 studies) for left ventricular systolic dysfunction (LVSD); 12.0{\%} (7.6{\%} to 17.2{\%}; 17 studies) for dilated cardiomyopathy; 29.3{\%} (22.6{\%} to 36.5{\%}; 20 studies) for grades I to III diastolic dysfunction; and 11.7{\%} (8.5{\%} to 15.3{\%}; 11 studies) for grades II to III diastolic dysfunction. The pooled incidence and prevalence of clinical heart failure were 0.9 per 100 person-years (0.4 to 2.1 per 100 person-years; 4 studies) and 6.5{\%} (4.4{\%} to 9.6{\%}; 8 studies), respectively. The combined prevalence of pulmonary hypertension and right ventricular dysfunction were 11.5{\%} (5.5{\%} to 19.2{\%}; 14 studies) and 8.0{\%} (5.2{\%} to 11.2{\%}; 10 studies), respectively. Significant heterogeneity was observed across studies for all the outcomes analyzed (I2 > 70{\%}, p < 0.01), only partly explained by available study level characteristics. There was a trend for lower prevalence of LVSD in studies reporting higher antiretroviral therapy use or lower proportion of acquired immune deficiency syndrome. The prevalence of LVSD was higher in the African region. After taking into account the effect of regional variation, there was evidence of lower prevalence of LVSD in studies published more recently. Conclusions: Cardiac dysfunction is frequent in people living with HIV. Additional prospective studies are needed to better understand the burden and risk of various forms of cardiac dysfunction related to HIV and the associated mechanisms. (Cardiac dysfunction in people living with HIV–a systematic review and meta-analysis; CRD42018095374)",
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AU - Erqou, Sebhat

AU - Lodebo, Bereket Tessema

AU - Masri, Ahmad

AU - Altibi, Ahmed M.

AU - Echouffo Tcheugui, Justin

AU - Dzudie, Anastase

AU - Ataklte, Feven

AU - Choudhary, Gaurav

AU - Bloomfield, Gerald S.

AU - Wu, Wen Chih

AU - Kengne, Andre Pascal

PY - 2019/2/1

Y1 - 2019/2/1

N2 - Objective: To synthesize existing epidemiological data on cardiac dysfunction in HIV. Background: Data on the burden and risk of human immunodeficiency virus (HIV) infection-associated cardiac dysfunction have not been adequately synthesized. We performed meta-analyses of extant literature on the frequency of several subtypes cardiac dysfunction among people living with HIV. Methods: We searched electronic databases and reference lists of review articles and combined the study-specific estimates using random-effects model meta-analyses. Heterogeneity was explored using subgroup analyses and meta-regressions. Results: We included 63 reports from 54 studies comprising up to 125,382 adults with HIV infection and 12,655 cases of various cardiac dysfunctions. The pooled prevalence (95% confidence interval) was 12.3% (6.4% to 19.7%; 26 studies) for left ventricular systolic dysfunction (LVSD); 12.0% (7.6% to 17.2%; 17 studies) for dilated cardiomyopathy; 29.3% (22.6% to 36.5%; 20 studies) for grades I to III diastolic dysfunction; and 11.7% (8.5% to 15.3%; 11 studies) for grades II to III diastolic dysfunction. The pooled incidence and prevalence of clinical heart failure were 0.9 per 100 person-years (0.4 to 2.1 per 100 person-years; 4 studies) and 6.5% (4.4% to 9.6%; 8 studies), respectively. The combined prevalence of pulmonary hypertension and right ventricular dysfunction were 11.5% (5.5% to 19.2%; 14 studies) and 8.0% (5.2% to 11.2%; 10 studies), respectively. Significant heterogeneity was observed across studies for all the outcomes analyzed (I2 > 70%, p < 0.01), only partly explained by available study level characteristics. There was a trend for lower prevalence of LVSD in studies reporting higher antiretroviral therapy use or lower proportion of acquired immune deficiency syndrome. The prevalence of LVSD was higher in the African region. After taking into account the effect of regional variation, there was evidence of lower prevalence of LVSD in studies published more recently. Conclusions: Cardiac dysfunction is frequent in people living with HIV. Additional prospective studies are needed to better understand the burden and risk of various forms of cardiac dysfunction related to HIV and the associated mechanisms. (Cardiac dysfunction in people living with HIV–a systematic review and meta-analysis; CRD42018095374)

AB - Objective: To synthesize existing epidemiological data on cardiac dysfunction in HIV. Background: Data on the burden and risk of human immunodeficiency virus (HIV) infection-associated cardiac dysfunction have not been adequately synthesized. We performed meta-analyses of extant literature on the frequency of several subtypes cardiac dysfunction among people living with HIV. Methods: We searched electronic databases and reference lists of review articles and combined the study-specific estimates using random-effects model meta-analyses. Heterogeneity was explored using subgroup analyses and meta-regressions. Results: We included 63 reports from 54 studies comprising up to 125,382 adults with HIV infection and 12,655 cases of various cardiac dysfunctions. The pooled prevalence (95% confidence interval) was 12.3% (6.4% to 19.7%; 26 studies) for left ventricular systolic dysfunction (LVSD); 12.0% (7.6% to 17.2%; 17 studies) for dilated cardiomyopathy; 29.3% (22.6% to 36.5%; 20 studies) for grades I to III diastolic dysfunction; and 11.7% (8.5% to 15.3%; 11 studies) for grades II to III diastolic dysfunction. The pooled incidence and prevalence of clinical heart failure were 0.9 per 100 person-years (0.4 to 2.1 per 100 person-years; 4 studies) and 6.5% (4.4% to 9.6%; 8 studies), respectively. The combined prevalence of pulmonary hypertension and right ventricular dysfunction were 11.5% (5.5% to 19.2%; 14 studies) and 8.0% (5.2% to 11.2%; 10 studies), respectively. Significant heterogeneity was observed across studies for all the outcomes analyzed (I2 > 70%, p < 0.01), only partly explained by available study level characteristics. There was a trend for lower prevalence of LVSD in studies reporting higher antiretroviral therapy use or lower proportion of acquired immune deficiency syndrome. The prevalence of LVSD was higher in the African region. After taking into account the effect of regional variation, there was evidence of lower prevalence of LVSD in studies published more recently. Conclusions: Cardiac dysfunction is frequent in people living with HIV. Additional prospective studies are needed to better understand the burden and risk of various forms of cardiac dysfunction related to HIV and the associated mechanisms. (Cardiac dysfunction in people living with HIV–a systematic review and meta-analysis; CRD42018095374)

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