Valvular manifestations of human immunodeficiency virus infection - results from the prospective, multicenter HIV-HEART study

Background and aimsHIV infection is associated with an elevated rate of cardiac diseases. The aim of the current study was to assess the prevalence of valvular disorders in a large population of HIV-infected patients.MethodsWe enrolled 803 adults (age 4410 years, 16.6% women) in this prospective, multicenter cohort study. All patients underwent a comprehensive two-dimensional transthoracic echocardiography examination including Doppler evaluation of valvular function. Statistical analyses were performed in respect of severity of HIV infection.ResultsOverall, the rate of patients with pathologic function of cardiac valves was 77.6% (N=623). Most of these patients had signs of valvular regurgitation (N=620; 77.2%), whereas stenoses were rare (N=23; 2.9%). Clinically relevant valvular disorders (excluding mild stages) were seen in only 4.7% (N=38; regurgitation: N=36, 4.5%; stenosis: N=3, 0.4%). Clinical stages of HIV infection, defined by the Centers for Disease Control and Prevention (CDC) classification, were associated with higher rates of valvular diseases (CDC-stage B/C versus A: 6.2 versus 2.3%, P=0.015). However, there was no association between current CD4 cell count or virus load and the prevalence of valvular disorders (both P>0.2). None of the patients had signs of active endocarditis in the present study.ConclusionValvular heart diseases are common in HIV-infected patients. Fortunately, most of these disorders are mild today. We found an association between the onset of valvular heart disease and clinical stages of HIV infection. (ClinicalTrials.gov number, NCT01119729).