HIV Infection and Risk of Cardiovascular Diseases Beyond Coronary Artery Disease

Area of Science:

• Cardiology
• Infectious Diseases
• Public Health

Background:

• Cardiovascular disease (CVD) is a growing concern for people living with HIV (PLWH), particularly in the era of effective antiretroviral therapy (ART).
• While coronary artery disease (CAD) is well-studied in PLWH, other CVD subtypes like heart failure (HF), cerebrovascular disease, and pulmonary hypertension are less understood.

Purpose of the Study:

• To review emerging evidence on non-coronary cardiovascular diseases (CVD) in people living with HIV (PLWH) during the post-antiretroviral therapy (ART) era.
• To highlight the increased risks and potential mechanisms of these CVD subtypes in the context of HIV infection and ART.

Main Methods:

• Literature review of recent studies focusing on cardiovascular outcomes in people living with HIV (PLWH).
• Analysis of evidence regarding heart failure, cerebrovascular disease, arrhythmias, pericardial disease, and pulmonary hypertension in the post-ART era.

Main Results:

• PLWH exhibit higher risks of heart failure (HF), with evidence of subclinical left ventricular dysfunction and myocardial abnormalities.
• Increased rates of atrial fibrillation, sudden cardiac death, and ischemic stroke are observed in PLWH, potentially linked to chronic inflammation and vasculopathy.
• Subclinical pericardial effusions are common, and pulmonary hypertension remains an underdiagnosed complication. PLWH face elevated risks for a broad spectrum of CVD.

Conclusions:

• People living with HIV (PLWH) remain at higher risk for diverse cardiovascular diseases (CVD), including non-coronary conditions, despite advancements in antiretroviral therapy (ART).
• Chronic inflammation is implicated as a significant factor contributing to the increased CVD burden in PLWH.
• Further research is crucial to fully understand the scope and mechanisms of non-coronary CVD in PLWH to guide clinical management.