Heart Failure among People with HIV: Evolving Risks, Mechanisms, and Preventive Considerations

Area of Science:

• Cardiology
• Infectious Diseases
• Public Health

Background:

• People with HIV (PHIV) on modern antiretroviral therapy (ART) face a doubled risk of heart failure compared to HIV-uninfected individuals.
• While advanced HIV/AIDS can cause reduced cardiac function, ART-treated HIV is linked to heart failure with reduced ejection fraction (HFrEF) or preserved ejection fraction (HFpEF).

Purpose of the Study:

• To review the evolving risks, mechanisms, and preventive strategies for heart failure in people with HIV.
• To address the increased incidence of heart failure, particularly HFpEF, in ART-treated PHIV.

Main Methods:

• Literature review of studies on HIV, ART, and cardiovascular outcomes.
• Analysis of mechanisms contributing to heart failure in PHIV, including diastolic dysfunction, myocardial fibrosis, and myocardial steatosis.
• Discussion of current challenges and future directions in cardiovascular risk management for PHIV.

Main Results:

• ART-treated HIV is associated with both HFrEF and HFpEF.
• Diastolic dysfunction, characterized by a "stiff" left ventricle, is a key feature of HFpEF in PHIV.
• Hypertension, immune activation, and metabolic dysregulation are common in ART-treated PHIV and contribute to myocardial fibrosis and steatosis, driving diastolic dysfunction.
• HFpEF is challenging to treat with conventional therapies and carries high morbidity and mortality.
• Diastolic dysfunction, myocardial fibrosis, and myocardial steatosis are potentially reversible.

Conclusions:

• Achieving UNAIDS 90-90-90 goals can reduce AIDS-related mortality, including cardiovascular deaths.
• Further research into the mechanisms predisposing ART-treated PHIV to heart failure, especially HFpEF, is crucial.
• Developing targeted preventive strategies is essential for preserving myocardial health in PHIV.