Cardiovascular disease and toxicities related to HIV infection and its therapies

Area of Science:

• Cardiology
• Infectious Diseases
• Public Health

Background:

• Cardiovascular manifestations in HIV infection are diverse, influenced by disease stage, treatment, and location.
• Prior to highly active antiretroviral therapy (HAART), common complications included dilated cardiomyopathy, myocarditis, and pericardial effusion.
• HAART has altered the disease course, leading to new cardiovascular concerns like metabolic syndrome and atherosclerotic heart disease.

Purpose of the Study:

• To review principal HIV-associated cardiovascular manifestations in patients not receiving HAART.
• To emphasize new knowledge on prevalence, pathogenesis, and treatment of cardiovascular complications in the HAART era.
• To discuss exercise as a non-pharmacological intervention for HAART-associated metabolic syndrome.

Main Methods:

• Literature review focusing on cardiovascular complications in HIV.
• Analysis of studies comparing cardiovascular issues in patients with and without HAART.
• Inclusion of recent research on pathogenesis and treatment strategies.

Main Results:

• Patients off HAART commonly experience dilated cardiomyopathy, myocarditis, pericardial effusion, endocarditis, pulmonary hypertension, and drug-related cardiotoxicity.
• In the HAART era, cardiovascular complications are increasingly linked to metabolic syndrome, hyperlipidemia, and atherosclerotic heart disease.
• Most HIV-infected individuals globally remain untreated with HAART, highlighting the continued relevance of understanding pre-HAART complications.

Conclusions:

• HIV-associated cardiovascular disease presentation varies significantly with and without HAART.
• Metabolic syndrome and atherosclerotic disease are key concerns in the HAART era.
• Exercise presents a potential non-pharmacological management strategy for HAART-related metabolic complications.