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Final Program


Program-At-A-Glance

Oral Abstracts Session

Virtual Recording

Session: Oral Abstracts Clinical Session 4

Sex Disparities in Intramyocardial Triglyceride Content and Myocardial Fibrosis in South African Youth with Perinatally-Acquired HIV Infection.

Saturday, February 7, 2026
11:20 AM - 11:30 AM  
Location: Asia IV and Hall 8 (3rd Floor)
Background: Despite drastic reductions in morbidity and mortality with the expansion of antiretroviral treatment (ART) worldwide, people with HIV infection carry an elevated risk of cardiovascular disease (CVD) compared to HIV-seronegative individuals.1-4 Increased intramyocardial triglyceride content (IMTG) and myocardial fibrosis are associated with diastolic dysfunction, adverse ventricular remodelling, ventricular systolic dysfunction and cardiomyopathy.1-3 No studies have evaluated levels of IMTG content in youth with HIV infection who do not have many of the traditional risk factors for cardiovascular disease. This study evaluated IMTG content, myocardial fibrosis and cardiovascular inflammatory biomarkers in youth with perinatally-acquired HIV (YPHIV).

Methods: Cardiovascular magnetic resonance (CMR) and magnetic resonance proton spectroscopy (1H-MRS) were used to assess myocardial structure, function, tissue characterisation and levels of IMTG content in YPHIV on antiretroviral therapy (ART). 1H-MRS was acquired by means of an ECG-triggered, respiratory-gated sequence using a 6x16x18mm voxel placed within the intra-ventricular septum. Pathologically elevated IMTG content was defined as >0.5%. Logistic regression models were fit to assess sex differences in IMTG content >0.5%, adjusting for confounders, and descriptive statistics were used to assess correlations of IMTG with inflammatory markers.

Results: Overall, 72 YPHIV [median age (interquartile range (IQR)) 18 years (17-19), 44% female] were included. Females YPHIV had a higher body mass index (BMI) [24 vs. 20kg/m2, p=0.002] compared to male YPHIV. Serum lipid levels, viral load (VL), CD4 count and current integrase inhibitor (INSTI) use were similar by sex. Overall 27% of participants had elevated IMTG. In addition to higher mean extracellular volume (ECV)% and native T1, female YPHIV were noted to have higher IMTG content [0.34 vs. 0.13%, p=0.003]. A higher proportion of female YPHIV had IMTG content >0.5% (42 vs. 17%), even after adjusting for age, BMI, VL, and INSTI-based ART use [unadjusted odds ratio (OR)=3.67, 95% confidence interval (CI): 1.14-11.84, p=0.03; adjusted OR=3.78, 95%CI: 0.98-14.63, p=0.05]. Furthermore, females had higher levels of galectin-3 (8.75 vs. 8.58 ng/mL, p=0.031) and IL6 (0.95 vs. 0.45 pg/mL, p=0.037) compared to males. On bivariate logistic regression analysis CRP was positively associated with IMTG (1.58 [1.09;2.28], p=0.016).

Conclusion: YPHIV on ART have elevated IMTG levels. Female YPHIV had >3 fold higher odds of elevated IMTG, as well as raised myocardial fibrosis and cardiovascular inflammatory biomarkers compared to male YPHIV. Further studies are needed to investigate the role of early screening, prevention, and intervention for these and other CVD-associated conditions in YPHIV, particularly in females.

CMR and 1H-MRS measure of myocardial steatosis, fibrosis and inflammation by sex

































Cardiac ParametersMalesFemalesp-value
Myocardial lipid content (%)0.13 (0.07-0.29)0.34 (0.15-1.33)0.003
Myocardial lipid > 0.5% (N (%))6 (16.7)11 (42.3)0.026
Mean native T1 map time (ms)1200.8 (27.7)1233.8 (32.3) < 0.001
Mean extracellular volume (%)27 (26-28)29 (28-30) 0.001
Participant characteristics

































































































































 

Males


Females


p-value


 


Nf40</span>


Nf32</span>

 

    Age (years)


18.23 (16.77-19.64)


17.55 (16.36-19.29)


0.29


    Family history of CVD


1 (2.56)


2 (6.25)


0.44


    Tobacco use


4 (10.00)


2 (6.25)


0.57


    BMI (kg/m2)


19.83 (18.80-22.16)


23.61 (20.19-26.28)


0.002


    BSA (m2)


1.60 (1.49-1.69)


1.53 (1.41-1.63)


0.14


    Waist-to-height ratio


0.43 (0.41-0.45)


0.48 (0.45-0.52)


< 0.001


    HOMA


2.44 (1.62-3.81)


3.82 (2.28-5.91)


0.071


    Total cholesterol (mmol/L)


137.84 (115.44-159.46)


137.84 (120.46-166.02)


0.63


    LDL-cholesterol (mmol/L)


76.83 (52.12-88.03)


68.34 (61.00-97.30)


0.55


    HDL-cholesterol (mmol/L)


46.72 (40.54-50.97)


50.39 (34.75-56.76)


0.84


    Triglycerides (mmol/L)


72.57 (54.87-97.35)


68.58 (52.21-95.58)


0.8


    CD4 Count

   

       < 200


1 (2.50)


4 (13.33)


0.17


          200 – 499


14 (35.00)


7 (23.33)

 

       > 500


25 (62.50)


19 (63.33)

 

    HIV Viral Load (log)


3.91 (3.66-4.05)


3.91 (3.66-9.80)


0.27


    Age at initiation of ART (years)


5.37 (2.08-7.64)


3.74 (1.22-5.32)


0.087


    Duration of ART (years)


13.58 (10.33-15.44)


14.66 (12.05-15.87)


0.16


    On INSTI ART regimen


12 (30.00)


8 (25.00)


0.64

Association between log-transformed inflammatory marker levels & IMTG