Myocardial Steatosis Among Antiretroviral Therapy-Treated People With Human Immunodeficiency Virus Participating in the REPRIEVE Trial

Tomas G Neilan; Kim-Lien Nguyen; Vlad G Zaha; Kara W Chew; Leavitt Morrison; Ntobeko A B Ntusi; Mabel Toribio; Magid Awadalla; Zsofia D Drobni; Michael D Nelson; Tricia H Burdo; Marije Van Schalkwyk; Paul E Sax; Daniel J Skiest; Karen Tashima; Raphael J Landovitz; Eric Daar; Alysse G Wurcel; Gregory K Robbins; Robert K Bolan; Kathleen V Fitch; Judith S Currier; Gerald S Bloomfield; Patrice Desvigne-Nickens; Pamela S Douglas; Udo Hoffmann; Steven K Grinspoon; Heather Ribaudo; Rodney Dawson; Matthew Bidwell Goetz; Mamta K Jain; Alberta Warner; Lidia S Szczepaniak; Markella V Zanni

doi:10.1093/infdis/jiaa245

Myocardial Steatosis Among Antiretroviral Therapy-Treated People With Human Immunodeficiency Virus Participating in the REPRIEVE Trial

J Infect Dis. 2020 Jul 9;222(Suppl 1):S63-S69. doi: 10.1093/infdis/jiaa245.

Authors

Tomas G Neilan¹, Kim-Lien Nguyen², Vlad G Zaha³, Kara W Chew⁴, Leavitt Morrison⁵, Ntobeko A B Ntusi⁶, Mabel Toribio⁷, Magid Awadalla¹, Zsofia D Drobni¹, Michael D Nelson⁸, Tricia H Burdo⁹, Marije Van Schalkwyk¹⁰, Paul E Sax¹¹, Daniel J Skiest¹², Karen Tashima¹³, Raphael J Landovitz¹⁴, Eric Daar¹⁵, Alysse G Wurcel¹⁶, Gregory K Robbins¹⁷, Robert K Bolan¹⁸, Kathleen V Fitch⁷, Judith S Currier⁴, Gerald S Bloomfield¹⁹, Patrice Desvigne-Nickens²⁰, Pamela S Douglas²¹, Udo Hoffmann¹, Steven K Grinspoon⁷, Heather Ribaudo⁵, Rodney Dawson²², Matthew Bidwell Goetz²³, Mamta K Jain²⁴, Alberta Warner², Lidia S Szczepaniak²⁵, Markella V Zanni⁷

Affiliations

¹ Cardiovascular Imaging Research Center, Department of Radiology and Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
² Division of Cardiology, David Geffen School of Medicine at the University of California, Los Angeles and the Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA.
³ Division of Cardiovascular Medicine, Department of Medicine, Advanced Imaging Research Center, Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
⁴ Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California, USA.
⁵ Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA.
⁶ Division of Cardiology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa.
⁷ Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
⁸ Applied Physiology and Advanced Imaging Laboratory, Department of Kinesiology, University of Texas at Arlington, Arlington, Texas, USA.
⁹ Department of Neuroscience, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, USA.
¹⁰ Family Clinical Research Unit, Division of Adult Infectious Diseases, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa.
¹¹ Division of Infectious Diseases, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
¹² Department of Medicine, University of Massachusetts Medical School-Baystate, Springfield, Massachusetts, USA.
¹³ Division of Infectious Diseases, The Miriam Hospital and Alpert Medical School of Brown University, Providence, Rhode Island, USA.
¹⁴ Center for Clinical AIDS Research and Education, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California, USA.
¹⁵ Lundquist Institute at Harbor-University of California, Los Angeles Medical Center and David Geffen School of Medicine at the University of Los Angeles, Los Angeles, California, USA.
¹⁶ Division of Geographic Medicine and Infectious Diseases, Department of Medicine, Tufts Medical Center, Boston, Massachusetts, USA.
¹⁷ Division of Infectious Diseases, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
¹⁸ Los Angeles Lesbian Gay Bisexual Transgender Center, Los Angeles, California, USA.
¹⁹ Duke Clinical Research Institute, Duke Global Health Institute, Department of Medicine, Duke University, Durham, North Carolina, USA.
²⁰ National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA.
²¹ Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA.
²² Division of Pulmonology and Department of Medicine, University of Cape Town Lung Institute, Mowbray, Cape Town, South Africa.
²³ Infectious Diseases Section, Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System and David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California, USA.
²⁴ Division of Infectious Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
²⁵ Biomedical Research Consulting in Magnetic Resonance Spectroscopy, Albuquerque, New Mexico, USA.

Abstract

Background: People with human immunodeficiency virus (PWH) face increased risks for heart failure and adverse heart failure outcomes. Myocardial steatosis predisposes to diastolic dysfunction, a heart failure precursor. We aimed to characterize myocardial steatosis and associated potential risk factors among a subset of the Randomized Trial to Prevent Vascular Events in HIV (REPRIEVE) participants.

Methods: Eighty-two PWH without known heart failure successfully underwent cardiovascular magnetic resonance spectroscopy, yielding data on intramyocardial triglyceride (IMTG) content (a continuous marker for myocardial steatosis extent). Logistic regression models were applied to investigate associations between select clinical characteristics and odds of increased or markedly increased IMTG content.

Results: Median (Q1, Q3) IMTG content was 0.59% (0.28%, 1.15%). IMTG content was increased (> 0.5%) among 52% and markedly increased (> 1.5%) among 22% of participants. Parameters associated with increased IMTG content included age (P = .013), body mass index (BMI) ≥ 25 kg/m2 (P = .055), history of intravenous drug use (IVDU) (P = .033), and nadir CD4 count < 350 cells/mm³ (P = .055). Age and BMI ≥ 25 kg/m2 were additionally associated with increased odds of markedly increased IMTG content (P = .049 and P = .046, respectively).

Conclusions: A substantial proportion of antiretroviral therapy-treated PWH exhibited myocardial steatosis. Age, BMI ≥ 25 kg/m2, low nadir CD4 count, and history of IVDU emerged as possible risk factors for myocardial steatosis in this group.

Clinical trials registration: NCT02344290; NCT03238755.

Keywords: HIV; MRS; cardiometabolic risk; cardiovascular magnetic resonance spectroscopy; heart failure; intramyocardial triglyceride content; myocardial steatosis.

Publication types

Randomized Controlled Trial
Research Support, N.I.H., Extramural

MeSH terms

Adipose Tissue
Anti-Retroviral Agents / therapeutic use
Body Mass Index
CD4 Lymphocyte Count
Cardiomyopathies / epidemiology*
Cardiomyopathies / pathology*
Female
HIV Infections / drug therapy
Heart Disease Risk Factors
Humans
Magnetic Resonance Imaging
Magnetic Resonance Spectroscopy
Male
Middle Aged
Triglycerides

Myocardial Steatosis Among Antiretroviral Therapy-Treated People With Human Immunodeficiency Virus Participating in the REPRIEVE Trial

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