Abstract
Antiretroviral therapy (ART) has transformed the clinical profile of human immunodeficiency virus (HIV) from an acute infection with a high mortality into a treatable, chronic disease. As a result, the clinical sequelae of HIV infection are changing as patients live longer. HIV-associated cardiomyopathy (HIVAC) is a stage IV, HIV-defining illness and remains a significant cause of morbidity and mortality among HIV-infected individuals despite ART. Causes and clinical manifestations of HIVAC depend on the degree of host immunosuppression. Myocarditis from direct HIV toxicity, opportunistic infections, and nutritional deficiencies are implicated in causing HIVAC when HIV viral replication is unchecked, whereas cardiac autoimmunity, chronic inflammation, and ART cardiotoxicity contribute to HIVAC in individuals with suppressed viral loads. The initiation of ART has dramatically changed the clinical manifestation of HIVAC in high income countries from one of severe, left ventricular systolic dysfunction to a pattern of subclinical cardiac dysfunction characterized by abnormal diastolic function and strain. In low and middle income countries, however, HIVAC is the most common HIV-associated cardiovascular disease. Clear diagnostic and treatment guidelines for HIVAC are currently lacking but should be prioritized given the global burden of HIVAC.
Highlights
Dramatic gains have been made in the treatment of human immunodeficiency virus (HIV) over the last decade
Much of the survival gains seen for people infected with HIV/acquired immunodeficiency syndrome (AIDS) are due to better availability of antiretroviral therapy (ART)
HIV-associated cardiomyopathy remains a significant cause of morbidity and mortality in both high income countries (HICs) and low and middle income countries (LMICs) despite the widespread use of ART
Summary
Dramatic gains have been made in the treatment of human immunodeficiency virus (HIV) over the last decade. Characteristic HIVAC Phenotype (i) More commonly seen in LMIC (ii) Symptomatic, systolic dysfunction +/− dilated ventricles (iii) Poor prognosis (i) More commonly seen in HIC (ii) Subclinical diastolic dysfunction with increased strain patterns dilation, any systolic impairment or diastolic dysfunction in asymptomatic HIV patients, and new onset heart failure in stage IV HIV disease [7]. This broadened classification of HIVAC illustrates the increasingly complex relationship between HIV and cardiac dysfunction. This review will explore the contributing etiologies of HIVAC while highlighting the current, disparate burden of HIVAC between HICs and LMICs
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