Etiology and pathophysiology of heart failure in people with HIV

Area of Science:

• Cardiology
• Infectious Diseases
• Immunology

Background:

• HIV-associated cardiomyopathy (HIVACM) remains a significant concern in people living with HIV (PHIV).
• Highly active antiretroviral therapy (HAART) has reduced AIDS-related mortality but not eliminated the risk of cardiomyopathy and heart failure in PHIV.
• Chronic HIV infection, even with HAART, is linked to persistent inflammation and immune dysregulation contributing to cardiac dysfunction.

Purpose of the Study:

• To review the proposed mechanisms underlying HIV-associated cardiomyopathy and heart failure in patients on HAART.
• To discuss the evolving pathophysiology of HIVACM since the introduction of HAART.
• To briefly cover the evaluation, work-up, and management of cardiomyopathy in PHIV.

Main Methods:

• Literature review of proposed mechanisms of HIV-associated cardiomyopathy.
• Analysis of the impact of HAART on HIVACM pathophysiology.
• Summary of current approaches to evaluation and management of cardiomyopathy in PHIV.

Main Results:

• HAART has shifted HIVACM from a rapidly progressive disease to a chronic condition characterized by inflammation and immune dysregulation.
• Despite HAART, PHIV experience elevated risks of cardiomyopathy and heart failure, independent of traditional cardiovascular risk factors.
• The increasing prevalence of cardiomyopathy and heart failure mortality in PHIV highlights the need for further research into immune-related mechanisms.

Conclusions:

• Chronic HIV infection and its treatment with HAART contribute to ongoing cardiac risks through inflammatory and immune pathways.
• Understanding these mechanisms is crucial for improving the evaluation and management of cardiomyopathy in people living with HIV.
• Further research into immune-related mechanisms may offer novel therapeutic targets for HIV-associated heart disease.