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Epidemiology of HIV cardiac disease
1University of California, San Diego, Division of Cardiology, UCSD Medical Center, San Diego, CA 92103-8411, USA. bcotter@ucsd.edu
Insights
Highly active antiretroviral therapy (HAART) has improved outcomes for human immunodeficiency virus (HIV) patients but may increase risks for premature coronary artery disease. Further research is needed to confirm if HAART accelerates heart conditions like myocardial infarcts.
Area of Science:
- Cardiology
- Infectious Diseases
- Public Health
Background:
- The heart is commonly affected in patients with acquired immune deficiency syndrome (AIDS).
- Highly active antiretroviral therapy (HAART) has significantly reduced mortality and morbidity in human immunodeficiency virus (HIV)-infected patients.
- Concerns exist regarding premature coronary artery disease (CAD) in young HIV patients, evidenced by increased myocardial infarct reports.
Purpose of the Study:
- To investigate the potential link between HAART and accelerated atherosclerosis in HIV-infected patients.
- To evaluate the incidence of coronary heart disease in the context of modern HIV treatment.
- To inform decisions regarding potential changes in HIV therapy protocols.
Main Methods:
- Review of existing case reports and retrospective studies on coronary heart disease in HIV patients.
- Analysis of data from ongoing large, prospective studies examining cardiovascular outcomes.
- Assessment of novel risk factors associated with HAART, including insulin resistance, dyslipidemia, and lipodystrophy syndrome.
Main Results:
- Reports indicate an increase in myocardial infarcts among young HIV-infected patients.
- HAART is associated with new cardiovascular risk factors: insulin resistance, dyslipidemia, and lipodystrophy syndrome.
- Current data on coronary heart disease incidence are primarily from limited case reports and retrospective analyses.
Conclusions:
- HAART may contribute to accelerated atherosclerosis and premature coronary artery disease in HIV patients.
- Prospective studies are crucial to determine if HAART increases myocardial infarct incidence.
- The findings will guide decisions on whether significant alterations in HIV treatment strategies are necessary.
Abstract:
The heart is an organ frequently affected in patients with acquired immune deficiency syndrome (AIDS). Since the introduction of highly active antiretroviral therapy (HAART), a sharp decline in mortality and morbidity has been observed in human immunodeficiency virus (HIV)-infected patients. However, numerous reports of myocardial infarcts in young HIV-infected patients have raised concerns of premature coronary artery disease in this population. New risk factors for coronary heart disease such as increased insulin resistance, dyslipidemia, and lipodystrophy syndrome, which are associated with HAART, may accelerate underlying arteriosclerosis in HIV-infected patients. Data on the incidence of coronary heart disease are limited to case reports and retrospective studies. Results from ongoing, large, prospective studies will provide information on whether or not HAART may increase the incidence of myocardial infarcts and whether a drastic change in HIV therapy is warranted.