Mentored Scientist Award

Cardiovascular Mechanisms of Post-Acute Sequalae of COVID-19 Among People Living with HIV

Headshot of Matthew Durstenfeld, MD
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People living with HIV (PLWH) have excess cardiovascular risk, and SARS-CoV-2 coinfection may further increase cardiovascular risk but has not yet been studied. In this proposal we plan to leverage the Long-term Impact of Infection with Novel Coronavirus (LIINC) study, a UCSF-run, longitudinal cohort of COVID-19 survivors, and will perform cardiopulmonary exercise testing among people with HIV and COVID-19. In Aim 1, we will compare objective exercise capacity (peak oxygen consumption or peak VO2) among people with HIV and COVID-19 who have post-acute sequalae of COVID-19 (PASC or “Long COVID) manifest in persistent cardiopulmonary symptoms 2-3 months after COVID-19 symptom onset with those who do not have cardiopulmonary symptoms at 2-3 months. In Aim 2, we will evaluate the association of reduced peak VO2 with cardiac function assessed by transthoracic echocardiogram and cardiac fibrosis assessed by cardiac magnetic resonance imaging. For both aims, we will determine the impact of COVID-19 disease severity, HIV disease characteristics, traditional risk factors, and biomarkers of cardiac injury and inflammation on structural abnormalities assessed by echocardiogram. Finally, by leveraging intensive assays performed in LIINC and philanthropic support to perform cardiac MRI, we will explore the association between immunologic and virologic assays and cardiovascular abnormalities among COVID-19 survivors with HIV infection. For aim 1, to compare outcomes the primary outcome of peak VO2 by symptom status, we will use t-test test and linear regression models to account for covariates. For aim 2, to assess the association between the primary outcome peak VO2 and cardiac imaging findings including strain, we will use linear regression models. The proposed study will provide critical preliminary data on mechanisms of cardiopulmonary symptoms among PLWH with PASC.