Background People with HIV (PWH) have an increased risk of cardiovascular disease (CVD). Cardiac magnetic resonance (CMR) has documented higher myocardial fibrosis, inflammation and steatosis in PWH, but studies have mostly relied on healthy volunteers as comparators and focused on men. Methods We investigated the associations of HIV and HIV-specific factors with CMR phenotypes in female participants enrolled in the Women’s Interagency HIV Study’s New York and San Francisco sites. Primary phenotypes included myocardial native (n) T1 (fibro-inflammation), extracellular volume fraction (ECV, fibrosis) and triglyceride content (steatosis). Associations were evaluated with multivariable linear regression, and results pooled or meta-analyzed across centers. Results Among 261 women with HIV (WWH, total n = 362), 76.2% had undetectable viremia at CMR. For the 82.8% receiving continuous antiretroviral therapy (ART) in the preceding 5 years, adherence was 51.7%, and 71.3% failed to achieve persistent viral suppression (42.2% with peak viral load < 200 cp/mL). Overall, WWH showed higher nT1 than women without HIV (WWOH) after full adjustment. This higher nT1 was more pronounced in those with antecedent or current viremia or nadir CD4+ count < 200 cells/μL, the latter also associated with higher ECV. WWH and current CD4+ count < 200 cells/μL had less cardiomyocyte steatosis. Cumulative exposure to specific ART showed no associations. Conclusions Compared with sociodemographically similar WWOH, WWH on ART exhibit higher myocardial fibro-inflammation, which is more prominent with unsuppressed viremia or CD4+ lymphopenia. These findings support the importance of improved ART adherence strategies, along with better understanding of latent infection, to mitigate cardiac end-organ damage in this population.

中文翻译：

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女性艾滋病毒、艾滋病毒特异性因素和心肌病

背景 HIV 感染者 (PWH) 患心血管疾病 (CVD) 的风险增加。心脏磁共振 (CMR) 记录了感染者的心肌纤维化、炎症和脂肪变性较高，但研究大多依赖健康志愿者作为比较者，并集中于男性。方法 我们调查了纽约和旧金山妇女机构间 HIV 研究中心登记的女性参与者中 HIV 和 HIV 特异性因素与 CMR 表型的关联。主要表型包括心肌天然 (n) T1（纤维炎症）、细胞外体积分数（ECV、纤维化）和甘油三酯含量（脂肪变性）。通过多变量线性回归评估关联性，并对跨中心的结果进行汇总或荟萃分析。结果 在 261 名 HIV 感染女性（WWH，总数 = 362）中，76.2% 的 CMR 检测不到病毒血症。在过去5年接受持续抗逆转录病毒治疗（ART）的82.8%中，依从率为51.7%，71.3%未能实现持续病毒抑制（42.2%的峰值病毒载量<200 cp/mL）。总体而言，在完全调整后，WWH 显示出比未感染 HIV 的女性 (WWOH) 更高的 nT1。这种较高的 nT1 在既往或当前病毒血症或最低 CD4+ 计数＜10% 的患者中更为明显。200 个细胞/μL，后者也与较高的 ECV 相关。WWH 和当前 CD4+ 计数 < 200个细胞/μL心肌细胞脂肪变性较少。特定 ART 的累积暴露没有显示出关联。结论 与社会人口统计学相似的 WWOH 相比，接受 ART 的 WWH 表现出更高的心肌纤维炎症，在未抑制的病毒血症或 CD4+ 淋巴细胞减少症中更为突出。这些发现支持了改进 ART 依从策略以及更好地了解潜伏感染的重要性，以减轻该人群的心脏终末器官损伤。