Myocardial Fibrosis among Antiretroviral Therapy-Treated Persons with Human Immunodeficiency Virus in South Africa

Scott R. Shuldiner, Lye Yeng Wong, Tess E. Peterson, Julian Wolfson, S. Jermy, H. Saad, Mbalabu A.J. Lumbamba, A. Singh, M. Shey, G. Meintjes, N. Ntusi, M. Ntsekhe, J. V. Baker

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9 Scopus citations


Background: Heart failure is a prominent cardiovascular disease (CVD) manifestation in sub-Sarahan Africa. Myocardial fibrosis is a central feature of heart failure that we aimed to characterize among persons with human immunodeficiency virus (PWH) in South Africa. Methods: Cardiovascular magnetic resonance (CMR) imaging was performed among PWH with viral suppression and uninfected controls, both free of known CVD. Plasma levels of N-terminal pro B-type natriuretic peptide (NT-proBNP) were measured. Comparisons by human immunodeficiency virus (HIV) status were made using linear and logistic regression, adjusted for age, sex, and hypertension. Results: One hundred thirty-four PWH and 95 uninfected persons completed CMR imaging; age was 50 and 49 years, with 63% and 67% female, respectively. Compared with controls, PWH had greater myocardial fibrosis by extracellular volume fraction ([ECV] absolute difference, 1.2%; 95% confidence interval [CI], 0.1-2.3). In subgroup analyses, the effect of HIV status on ECV was more prominent among women. Women (vs controls) were also more likely to have elevated NT-proBNP levels (>125 pg/mL; odds ratio, 2.4; 95% CI, 1.0-6.0). Among all PWH, an elevated NT-proBNP level was associated with higher ECV (3.4% higher; 95% CI, 1.3-5.5). Conclusions: Human immunodeficiency virus disease may contribute to myocardial fibrosis, with an effect more prominent among women. Research is needed to understand heart failure risk among PWH within sub-Saharan Africa.

Original languageEnglish (US)
Article numberofaa600
JournalOpen Forum Infectious Diseases
Issue number1
StatePublished - Jan 1 2021

Bibliographical note

Funding Information:
This study was funded by the National Heart Lung and Blood Institute, National Institutes of Health (R21 HL137435) and the American Heart Association (17IRG33350064). This work was also supported in part by the Doris Duke Charitable Foundation through a grant supporting the Doris Duke International Clinical Research Fellows Program at the University of Minnesota. G. M. was supported by the Wellcome Trust (098316, 214321/Z/18/Z, and 203135/Z/16/Z) and the South African Research Chairs Initiative of the Department of Science and Technology and National Research Foundation of South Africa (Grant Number 64787).

Publisher Copyright:
© 2020 The Author(s) 2020. Published by Oxford University Press on behalf of Infectious Diseases Society of America.


  • HIV
  • South Africa
  • cardiovascular disease
  • myocardial fibrosis


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