HIV Linked to Early Signs of Heart Dysfunction

PEOPLE living with HIV may experience subtle changes in heart muscle function even when conventional measures of cardiac performance remain normal, according to findings from a systematic review and meta-analysis.

Researchers identified significantly impaired global longitudinal strain (GLS) among people with HIV compared with HIV-uninfected individuals, despite preserved left ventricular ejection fraction (LVEF) in both groups. The findings suggest that speckle-tracking echocardiography (STE) could provide additional information about early myocardial dysfunction in this population.

Cardiovascular Risk in People Living With HIV

People with HIV face an increased risk of cardiovascular complications, including changes in cardiac structure and function, even with effective antiretroviral therapy.

However, conventional echocardiographic measurements, particularly LVEF, may not detect early myocardial abnormalities. As a result, subtle changes in heart muscle function can remain unidentified until more advanced dysfunction develops.

GLS, measured using STE, assesses myocardial deformation during contraction and may identify functional changes before they become apparent through conventional measures.

To investigate its potential value, researchers conducted a systematic review and meta-analysis of studies comparing myocardial strain in people with HIV and HIV-uninfected individuals.

The analysis followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and included studies identified through PubMed, Embase, Scopus, and Web of Science.

Subclinical Myocardial Impairment Identified

Six comparative studies involving 749 participants were included in the meta-analysis, comprising 469 people with HIV and 280 HIV-uninfected individuals.

Importantly, all six studies reported preserved LVEF in both groups, indicating that conventional systolic function measurements remained within normal ranges.

Despite this, pooled analysis demonstrated significantly less negative GLS values among people with HIV, with a mean difference of 0.98 percentage points (95% CI 0.15–1.80).

Because GLS values are normally negative, less negative measurements indicate reduced myocardial shortening and may reflect impaired cardiac muscle function.

The findings were consistent with mild subclinical myocardial impairment among people with HIV, even in the absence of overt systolic dysfunction.

Sensitivity analyses supported the stability of the pooled findings. However, substantial heterogeneity was observed between studies (I²=77.8%), suggesting considerable variation in the reported effects.

Three additional studies evaluating myocardial strain exclusively in people with HIV also supported the presence of early functional alterations despite preserved conventional systolic function.

Could Advanced Imaging Improve Cardiac Assessment?

The findings highlight the potential limitations of relying exclusively on LVEF when assessing cardiovascular health in people with HIV.

By detecting subtle abnormalities in myocardial deformation, STE may offer an additional method for identifying individuals with early cardiac changes that would otherwise remain undetected.

This could be particularly relevant given the elevated cardiovascular risk associated with HIV and the importance of recognising myocardial dysfunction before more substantial impairment develops.

However, the researchers emphasised that the available evidence was predominantly cross-sectional, meaning the observed association does not establish that HIV directly causes myocardial dysfunction.

Furthermore, the analysis did not determine whether impaired GLS predicts subsequent cardiovascular events or whether routine strain imaging would improve clinical outcomes.

The researchers concluded that people with HIV demonstrate mild impairment in myocardial deformation despite preserved LVEF, supporting further investigation of STE as an additional cardiovascular assessment tool.

Prospective studies, particularly in regions with a high HIV burden, are needed to establish the prognostic significance of these findings and determine whether GLS assessment should be incorporated into routine cardiovascular care.

Reference

Mutengo et al. Global longitudinal strain in people with HIV compared with HIV-uninfected individuals: a systematic review and meta-analysis of speckle-tracking echocardiography studies. BMC Cardiovasc Disord (2026). https://doi.org/10.1186/s12872-026-06484-3