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Heart and HAART: Two sides of the coin for HIV-associated cardiology issues
1Giuseppe Barbaro, Cardiology Unit, Department of Medical Pathophysiology, Policlinico Umberto I°, University "La Sapienza", 00174 Rome, Italy.
Insights
Highly active antiretroviral therapy (HAART) impacts HIV-associated cardiomyopathy differently worldwide. While reducing it in developed nations, HAART may increase cardiomyopathy and heart failure in developing countries, necessitating cardiac monitoring.
Area of Science:
- Cardiology
- Infectious Diseases
- Public Health
Background:
- Highly active antiretroviral therapy (HAART) has altered the cardiac manifestations of acquired immunodeficiency syndrome (AIDS).
- Developed countries see reduced HIV-associated cardiomyopathy, possibly due to fewer opportunistic infections and myocarditis.
- Developing countries face increased HIV-cardiomyopathy and mortality due to limited HAART access and nutritional factors.
Purpose of the Study:
- To analyze the contrasting effects of HAART on cardiac manifestations in HIV-infected individuals across different global regions.
- To highlight the emergence of iatrogenic metabolic syndrome and accelerated atherosclerosis in patients on certain HAART regimens.
- To emphasize the need for vigilant cardiac screening and collaborative care in managing HIV patients on HAART.
Main Methods:
- Comparative analysis of epidemiological data on HIV-associated cardiomyopathy prevalence.
- Review of studies on HAART regimens, including protease inhibitors, and their metabolic side effects.
- Assessment of cardiovascular risk factors and outcomes in HIV-infected populations.
Main Results:
- A 30% reduction in HIV-associated cardiomyopathy in developed countries versus a 32% increase in developing countries.
- Certain HAART regimens, particularly those with protease inhibitors, are linked to metabolic syndrome (HIV-lipodystrophy) and accelerated atherosclerosis.
- Increased risk of cardiovascular events, including in younger HIV-infected individuals.
Conclusions:
- HAART's impact on cardiac health in HIV patients is region-dependent, influenced by therapy access and nutritional status.
- Iatrogenic metabolic syndrome and accelerated atherosclerosis are significant concerns with specific HAART regimens.
- Close cardiac screening, risk stratification, and collaboration between cardiologists and infectious disease specialists are crucial for managing HIV patients on HAART.
Abstract:
The introduction of highly active antiretroviral therapy (HAART) has generated a contrast in the cardiac manifestations of acquired immunodeficiency syndrome. In developed countries, we have observed an approximately 30% reduction in the prevalence of human immunodeficiency virus (HIV)-associated cardiomyopathy, possibly related to a reduction of opportunistic infections and myocarditis. In developing countries, however, where the availablity of HAART is limited and the pathogenic impact of nutritional factors is significant, we have observed an approximately 32% increase in the prevalence of HIV-associated cardiomyopathy and a related high mortality rate from congestive heart failure. Also, some HAART regimens in developed countries, especially those including protease inhibitors, have been shown to cause, in a high proportion of HIV-infected patients, an iatrogenic metabolic syndrome (HIV-lipodystrophy syndrome) that is associated with an increased risk of cardiovascular events related to a process of accelerated atherosclerosis, even in young HIV-infected people. Careful cardiac screening is warranted for patients who are being evaluated for, or who are receiving, HAART regimens, particularly for those with known underlying cardiovascular risk factors. A close collaboration between cardiologists and infectious disease specialists is needed for decisions regarding the use of antiretrovirals, for a careful stratification of cardiovascular risk factors, and for cardiovascular monitoring of HIV-infected patients receiving HAART, according the most recent clinical guidelines.
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