Incidence and Progression of Diastolic Dysfunction in People With HIV in Tanzania: A Comparative Cohort

Background: People living with HIV (PLWH) have a higher prevalence of diastolic dysfunction and left ventricular hypertrophy (LVH) in cross-sectional studies. Longitudinal data are lacking, especially from Africa.

Objectives: The aim was to examine: 1) the incidence of diastolic dysfunction in PLWH compared to community controls in Tanzania; 2) the progression of diastolic function and LVH in PLWH after antiretroviral therapy initiation; and 3) traditional, endemic, and HIV-specific risk factors for diastolic function and LVH.

Methods: This was a prospective longitudinal cohort of PLWH and HIV-uninfected controls who had an echocardiogram at enrollment and in follow-up. Adjusted Cox proportional HR models were used to determine the incidence of diastolic dysfunction, and multivariable mixed effects regressions were used to determine the progression and risk factors for diastolic function.

Results: A total of 781 participants (367 PLWH) were followed for up to 5 years. There was no difference in incidence of diastolic dysfunction by HIV serostatus (aHR: 0.93 [95% CI: 0.61-1.42]). Baseline differences in echo parameters prior to antiretroviral therapy initiation resolved within 3 years of treatment for LVH (baseline difference = 3.57 g/m² [95% CI: 0.87-6.26]; no difference after 3 years) and other diastolic dysfunction markers. Hypertension and obesity were important modifiable risk factors for diastolic dysfunction (both P < 0.001), while subclinical kidney disease, anemia, and manual labor were predictors of LVH and diastolic dysfunction.

Conclusions: The incidence of diastolic dysfunction was similar in PLWH and HIV-uninfected controls. Efforts to prevent diastolic heart failure in Africa must focus on addressing hypertension and obesity while also investigating nontraditional risk factors.