Characterisation of Cardiovascular Disease in African youth with perinatally-acquired HIV infection in the era of antiretroviral therapy

Antiretroviral therapy has increased survival in people with HIV. Children with perinatally-acquired HIV are now reaching adulthood in growing numbers. It is becoming increasingly apparent that despite ART, young people with perinatally-acquired HIV (YWH) experience multi-system comorbidities, which result in considerable disability. Cardiac disease is one of the most common comorbidities among African YWH and has often been investigated using transthoracic echocardiography (TTE). Whilst TTE provides information on myocardial function, it remains insensitive to detect tissue-level pathology such as fibrosis or oedema and does not provide any information on presence and extent of coronary artery disease (CAD). In adults, HIV-associated cardiac disease is believed to be driven by atherosclerosis, but studies have not established this in YWH. My fellowship will interrogate the hypothesis that in YWH, cardiac disease is due to a primary myocardial pathology and not due to CAD. I will conduct a cohort study using state-of-the-art advanced imaging techniques including cardiac magnetic resonance and computed tomography coronary angiography, combined with biochemical profiling, to characterise cardiac pathology, including the presence and extent of CAD, in YWH aged 17-27 years, presenting with an echocardiography abnormality. YWH will be followed-up at 24 months to investigate progression of cardiac pathology.