Lipotoxic mediated cardiac remodeling and adipokine imbalance in perinatally HIV-infected young adults: the COVERTE Study
F Boccara, L Soulat-Dufour, P Nhan, C Arnaud, N Haddour, S Ederhy, Y Ancedy, M Chauvet-Droit, C Vigouroux, J P Bastard, S Fellahi, J P Viard, J Warszawski, J Lechenadec, A CohenAbstract
Background and Aims
Whether perinatally infected young adults living with HIV (pPWH) exhibit a specific cardiometabolic and cardiac phenotype remains insufficiently characterized. We aimed to compare cardiometabolic parameters and cardiac structure and function between pPWH and HIV-negative controls.
Methods
Clinical and biochemical parameters, along with comprehensive cardiovascular assessment including transthoracic echocardiography with off-line ventricular strain analysis, carotid ultrasound for intima–media thickness measurement, and aortic pulse wave velocity (PWV) evaluation, were performed in a cohort of 18–25-year-old perinatally infected people living with HIV (pPWH) and age- and sex-matched HIV-negative controls. Cross-sectional comparisons were performed using univariate and multivariable analyses.
Results
Among the 150 participants (60% female; median age 22 years), 82 were pPWH and 68 were controls. Compared with controls, pPWH exhibited a less favorable metabolic profile, including higher waist-to-hip ratio (0.90 vs 0.80, p < 0.001), triglyceride levels (0.9 vs 0.8 mmol/L, p = 0.01), and HOMA-IR (1.8 vs 1.7, p = 0.02), along with lower HDL-cholesterol (1.3 vs 1.5 mmol/L, p = 0.007) and adiponectin levels (5.3 vs 5.9 mg/L, p = 0.001) without significant difference in body mass index between the two groups (22.4 ± 3.7 vs 21.5 ± 2.5 kg/m²; p = 0.09). Markers of monocyte activation and fibrinolysis, namely sCD14 and PAI-1, were significantly higher (both p < 0.02). Echocardiographic analysis (Table 1) showed higher indexed left ventricular (LV) mass in pPWH, reduced LV global longitudinal strain (LVGLS), and right ventricular (RV) free wall strain (RVFWS). The prevalence of impaired RV longitudinal strain (<20%) was significantly higher in pPHIV. LV ejection fraction (LEVF) and the prevalence of overt systolic dysfunction (LVEF <50%) did not differ between the two groups. Carotid intima-media thickness and aortic PWV parameters were similar (all p > 0.05).Multivariable linear regression analysis showed the following: Absolute LVGLS was positively associated with adiponectin levels (β = 0.14; 95% CI 0.01–0.24; p = 0.03).Absolute RVFWS was independently negatively associated with HIV infection (β = −3.36; 95% CI −4.94 to −1.77; p < 0.001) and positively associated with adiponectin (β = 0.39; 95% CI 0.20–0.58; p < 0.001).LV mass index was independently associated with HIV infection (adjusted difference 6.22 g/m²; 95% CI 2.03–10.42; p < 0.01), whereas female sex was independently associated with lower LV mass index (−10.33 g/m²; 95% CI −14.59 to −6.06; p < 0.001).
Conclusions
Perinatally HIV-infected young adults exhibit subclinical but significant cardiometabolic abnormalities, characterized by relative insulin resistance, reduced adiponectin levels, and early cardiac remodeling with impaired LV and RV ventricular myocardial strains despite preserved LVEF.Table