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

ABSTRACT

BACKGROUND AND AIMS: HIV 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. METHODS: We enrolled 803 adults (age 44 ± 10 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. RESULTS: Overall, 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. CONCLUSION: Valvular 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.