The association between current CD4 counts and subclinical myocardial injury by cardiac magnetic resonance in HIV: independence from cardiovascular risk factors

OBJECTIVES: To evaluate the association between immune status and subclinical myocardial injury by cardiovascular magnetic resonance (CMR) in people with HIV (PWH), independent of traditional cardiovascular risk factors. DESIGN: This prospective study enrolled 98 PWH without known cardiovascular disease (CVD) and 91 Framingham Risk Score (FRS)-matched non-HIV controls. METHODS: Myocardial function and tissue characteristics were assessed by CMR, including native T1/T2 mapping, extracellular volume fraction (ECV), and late gadolinium enhancement (LGE). Immunologic and treatment-related variables included duration of HIV infection, duration of ART, HIV viral load, current and nadir CD4+ and CD8+ T-cell counts, and CD4/CD8 ratio. Linear and logistic regression analyses adjusted for FRS and heart rate evaluated associations between immunologic parameters and CMR findings. RESULTS: PWH demonstrated elevated global native T1, T2, ECV, and LGE, with reduced global longitudinal strain (GLS) and global circumferential strain (GCS) compared with non-HIV controls (all P < 0.05). In multivariate analysis, current CD4+ T-cell counts correlated negatively with global native T1 (β = -0.361, P < 0.001) and ECV (β = -0.318, P = 0.001). Current CD4+ cell count <200 cells/μl was independently associated with elevated native T1 [odds ratio (OR), 7.199; 95% confidence interval (CI), 1.373-37.746; P = 0.020] and elevated ECV (OR, 5.152; 95% CI, 1.260-21.062; P = 0.023). CONCLUSION: PWH exhibit subclinical myocardial fibrosis and dysfunction despite similar FRS to non-HIV controls. Current CD4+ T-cell counts <200 cells/μl is an independent predictor of subclinical myocardial injury.