Characteristics, Prevention, and Management of Cardiovascular Disease in People Living With HIV: A Scientific...

Area of Science:

• Cardiology
• Infectious Diseases
• Public Health

Background:

• HIV has shifted from a fatal illness to a chronic condition with increased risk of comorbidities.
• People with HIV experience significantly higher rates of cardiovascular diseases (CVDs) like myocardial infarction, heart failure, and stroke compared to uninfected individuals.
• These elevated CVD risks persist even with viral suppression and are linked to chronic inflammation and immune dysregulation.

Purpose of the Study:

• To comprehensively review existing evidence on HIV-associated cardiovascular diseases, focusing on atherosclerotic CVD and heart failure.
• To provide pragmatic recommendations for CVD prevention and treatment in people living with HIV.
• To address the need for improved understanding and management strategies due to limited long-term outcome data.

Main Methods:

• Review of large observational studies.
• Analysis of randomized controlled trials of HIV therapies (noting limitations for CVD endpoints).
• Examination of small interventional studies using surrogate CVD endpoints.

Main Results:

• Elevated risks for myocardial infarction, heart failure, stroke, pulmonary hypertension, and sudden cardiac death in people with HIV.
• Persistence of these risks after accounting for demographic and clinical factors.
• Attribution of increased risk partly to chronic inflammation and immune dysregulation associated with HIV.

Conclusions:

• HIV infection is associated with a substantially increased burden of cardiovascular disease.
• Effective antiretroviral therapy manages HIV but does not fully eliminate CVD risk.
• Further research and tailored clinical strategies are crucial for CVD prevention and management in the growing population of people living with HIV.