Abstract
Highly active antiretroviral therapy (HAART) allows chronicity of AIDS evolution, leading to association of other pathologies such as coronary artery disease (CAD). Myocardial ischemia (MI) and left ventricular diastolic dysfunction (LVDD) evaluation in HIV-infected patients may favor primary prevention of CAD. The study aimed to evaluate frequencies of MI and LVDD in the population living with the human immunodeficiency virus (PLHIV) and asymptomatic for CAD. We analyzed data from 110 HIV-infected patients who underwent clinical and laboratory evaluation, treadmill exercise stress test, and transthoracic echocardiogram, and compared it with 2,619 healthy individuals from the control group (non-HIV and non-CAD), selected from the database. HIV-infected patients presented lower average age (51.5 ± 7.7), systemic arterial hypertension (28.0%) and dyslipidemia frequencies (32.0%). On the other hand, their MI frequency was twice as high (14.7%); and diastolic dysfunction (DD) percentage was higher in ischemic patients (45.5%). In the HIV-infected group, MI frequency was 10.0%, while that of DD was 18.2%. MI was twice as frequent among HIV infected patients compared to uninfected, despite lower frequency of risk factors for CAD. Non-ischemic patients living with HIV had a frequency of DD more than twice compared to the control individuals.
Highlights
In 2020, the population living with the human immunodeficiency virus (PLHIV) was estimated at 37.7 million people worldwide, 73% of PLHIV received antiretroviral therapy (ART), and approximately 1,5000,000 were newly infected in 2020 (WHO, 2021)
These findings are present even if HIV infection is under reasonable control (CD4 + count above 200 cells/mm3 and undetectable viral load (VL) in most patients, besides use of highly active antiretroviral therapy (HAART) regimen)
Literature really points to the fact such behavior is due to HIV infection and its treatment - ART use (Koenig, 2017; Lang et al, 2015; Vilela et al, 2011), with inflammation and immunological activation widely proven as HIV infection part, contributing to coronary artery disease (CAD) emergence (Boettiger et al, 2020; Freiberg et al, 2013; Vachiat et al, 2017)
Summary
In 2020, the population living with the human immunodeficiency virus (PLHIV) was estimated at 37.7 million people worldwide, 73% of PLHIV received antiretroviral therapy (ART), and approximately 1,5000,000 were newly infected in 2020 (WHO, 2021). From 1997 onwards, the advent of highly effective or highly active antiretroviral therapy (HAART) brought a new perspective to the course of HIV infection as it provided control of viral load (VL) and consequent increase in life expectancy of these patients, transforming it into a chronic medical condition. As the incidence of opportunistic infections declines, prevalence of non-HIV/AIDS-related comorbidities, including CVD, continues to rise among HIV-infected patients compared to uninfected (Toribio et al, 2017). Pathogenesis of this disorder encompasses complicated interactions between effects of chronic HIV infection, antiretroviral use, and patient's own factors, including genetic susceptibility
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