Characteristics Of Echocardiography And Carotid Ultrasound In Patients With HIV/AIDS And Analysis Of Factors Affecting The Presence Of Abnormalities

PurposeWith the use of antiretroviral therapy（ART）,the life expectancy of the human immunodeficiency virus（HIV）-infected patients with Acquired immunodeficiency syndrome（AIDS）has increased.The life expectancy of patients is rising,and the population is aging and increasingly affected by age-related non-communicable diseases（NCD）,among which HIV-associated cardiovascular disease（CVD）is gaining attention.Therefore,this study focuses on the factors influencing the abnormalities of echocardiography and carotid ultrasound in patients with HIV/AIDS.Methods（1）A retrospective study was conducted to select patients with HIV/AIDS who visited the Third People’s Hospital of Kunming from December 1,2020,to November30,2021,for echocardiography and/or carotid ultrasound and to collect the patients’basic information and ultrasound findings.（2）A total of 386 patients were included in the echocardiographic study,and the patients were divided into a normal echocardiographic group（231 patients）and an abnormal echocardiographic group（155 patients）according to whether the echocardiogram was abnormal or not.Patients were divided into the group with normal left ventricular diastolic function（286 cases）and the group with left ventricular diastolic dysfunction（100 cases）according to whether left ventricular diastolic dysfunction occurred.（3）A total of 326 patients were included in the study of carotid ultrasound,and the patients were divided into the group with normal carotid ultrasound（222 patients）and the group with abnormal carotid ultrasound（104 patients）according to whether the carotid ultrasound was abnormal or not.The patients were divided into 80 cases in group A（untreated）,114cases in group B（treated for<5 years）,and 132 cases in group C（treated for≥5years）according to the period of ART treatment;（4）The chi-square test,logistic regression,and multiple correspondence analysis were performed using SPSS26.0,and Graph Pad Prism 8.0 software was used to plot the results of the analysis of influencing factors.Results1.Characterization of epidemiological data and ultrasound findings in patients with HIV/AIDS Patients with HIV/AIDS present more often with overweight or obesity,smoking,alcohol consumption,hypertension,diabetes,and hyperlipidemia;sexual transmission is the main route of infection in patients;virological unsuppression and low immune system CD₄still exist.Echocardiographic abnormalities in patients with HIV/AIDS were 40.2%,with left ventricular diastolic dysfunction being the most common（25.9%）,followed by pulmonary artery systolic pressure elevation（8.3%）,pericardial effusion（7.0%）,aortic calcification（6.0%）,aortic regurgitation（4.9%）,ventricular septal thickening（3.9%,）,increased left atrial internal diameter（2.8%）,and atrial septal thickening（1.6%）.The rate of carotid ultrasound abnormalities in HIV/AIDS patients was 31.9%,and among the abnormal findings,carotid plaque formation（27.0%）was higher than IMT thickening（6.7%）.2.Analysis of factors affecting echocardiographic abnormalities in patients with HIV/AIDS The abnormality rate of echocardiography was 40.2%（155/386）in 386HIV/AIDS patients.Multifactorial logistic regression analysis showed that age>44（non-youth）（OR=3.579,95%CI:2.200～5.823,P<0.001）,having hypertension（OR=1.847,95%CI.1.075 to 3.175,P=0.026）,had hyperlipidemia（OR=1.868,95%CI:1.120 to 3.115,P=0.017）,had HIV infection（OR=2.330,95%CI:1.551 to 3.500,P<0.001）,and was on ART（OR=1.855,95%CI.1.029 to 3.345,P=0.040）were influential factors in the presence of abnormal echocardiograms in patients with HIV/AIDS.3.Analysis of factors influencing left ventricular diastolic dysfunction in patients with HIV/AIDS Abnormal echocardiographic findings in HIV/AIDS patients were most commonly associated with left ventricular diastolic dysfunction 25.9%（100/386）.Multifactorial logistic regression analysis showed that age>44（non-youth）（OR=9.294,95%CI:4.610-18.736,P<0.001）,BMI≥24.0 kg/m²（OR=2.279,95%CI:1.181-4.401,P=0.014）,presence of hypertension（OR=1.926,95%CI:1.069-3.471,P=0.014）,and the presence of hypertension（OR=1.926,95%CI:1.069-3.471,P=0.014）were the most common.95%CI:1.069-3.471,P=0.029),hyperlipidemia（OR=1.999,95%CI:1.126-3.548,P=0.018）and HIV infection（OR=2.003,95%CI:1.341-2.992,P=0.001）were factors influencing the development of LV diastolic dysfunction in patients with HIV/AIDS.4.Analysis of factors influencing carotid ultrasound abnormalities in patients with HIV/AIDS The abnormality rate of carotid ultrasound was 31.9%（104/326）in 326 HIV/AIDS patients.Multiple correspondence analysis showed that carotid ultrasound results were more likely to be normal in patients aged≤44 years（young）,BMI<24.0 kg/m2,without hypertension,without diabetes mellitus,without hyperlipidemia,without ART treatment and treatment duration<5 years,and with CD₄⁺T lymphocyte count≥200 cells/ul.Carotid ultrasound findings were more likely to be abnormal in HIV/AIDS patients with age>44 years（not young）,BMI≥24.0kg/m2,hypertension,diabetes mellitus,hyperlipidemia,duration of ART treatment≥5years,and CD₄⁺T lymphocyte count<200 cells/ul.5.Analysis of factors influencing carotid ultrasound abnormalities in HIV/AIDS patients with ART during different treatments The abnormality rates of carotid ultrasound in each group A,B,and C were 25.0%（20/80）,28.9%（33/114）,and 38.6%（51/132）.Multifactorial logistic regression analysis showed that age>44（non-youth）（OR=9.116,95%CI:2.403-34.577,P=0.001）was an influential factor in the presence of abnormal carotid ultrasound in group A patients;age>44（non-youth）（OR=11.550,95%CI:2.931-45.513,P<0.001）,body mass index BMI≥24.0kg/m2（OR=5.719,95%CI:5.719,5.719）,and body mass index BMI≥24.0 kg/m²（OR=5.719,95%CI:5.719）.5.719,95%CI:1.202-27.215,P=0.028)and the presence of hypertension（OR=10.598,95%CI:3.009-37.324,P<0.001）were factors influencing the presence of abnormal carotid ultrasound in group B patients;age>44（not young）（OR=5.863,95%CI:1.840-18.684,P=0.003）,the presence of hypertension（OR=4.274,95%CI:1.567-11.659,P=0.005）the presence of hyperlipidemia（OR=2.792,95%CI:1.083-7.195,P=0.034）and the presence of protease inhibitors in the ART regimen（OR=2.315,95%CI.1.018-8.264,P=0.045）were influential factors in the presence of abnormal carotid ultrasound in group C patients.Conclusion（1）The rate of echocardiographic abnormalities in HIV/AIDS patients was40.2%,and left ventricular diastolic dysfunction was the most common;the rate of carotid ultrasound abnormalities was 31.9%,and the formation of carotid plaque was higher than IMT thickening in the abnormal findings.（2）Age>44（non-youth）,hypertension,hyperlipidemia,HIV infection,and being treated with ART were influential factors for echocardiographic abnormalities in HIV/AIDS patients.（3）Age>44（non-youth）,BMI≥24.0 kg/m²,hypertension,hyperlipidemia,and HIV infection were influential factors for the development of left ventricular diastolic dysfunction in patients with HIV/AIDS.（4）Carotid ultrasound was more likely to be abnormal in HIV/AIDS patients who were age>44（non-youth）,had BMI≥24.0 kg/m²,had hypertension,had diabetes mellitus,had hyperlipidemia,had been treated with ART for≥5 years and had CD₄⁺T lymphocyte count<200 cells/ul.（5）Age>44（non-youth）was a factor influencing abnormal carotid ultrasound in the HIV/AIDS untreated group;age>44（non-youth）,body mass index BMI≥24.0kg/m²,and hypertension were factors influencing abnormal carotid ultrasound in the HIV/AIDS treated<5 years group;age>44（non-youth）,hypertension,hyperlipidemia and the presence of protease inhibitors in the ART regimen were factors influencing abnormal carotid ultrasound in the HIV/AIDS treated<5 years group.The presence of protease inhibitors in the ART regimen was a factor influencing the presence of abnormal carotid ultrasound in patients in the HIV/AID treatment duration≥5 years group.