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The hidden continuum of HIV-associated cardiomyopathy: A focussed review with case reports

Pieter-Paul S Robbertse1, Anton F Doubell1, Jean B Nachega2,3,4

  • 1Division of Cardiology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Tygerberg, South Africa.

SA Heart Journal
|May 9, 2022
PubMed

Insights

HIV-associated cardiomyopathy (HIVAC) presents with asymptomatic myocardial abnormalities, even at HIV diagnosis. Understanding these early signs is crucial for prognosis and managing heart conditions in people with HIV.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Medical Imaging

Background:

  • HIV-associated cardiomyopathy (HIVAC) is poorly understood with a grim prognosis post-ventricular dysfunction.
  • Asymptomatic myocardial abnormalities are prevalent in people living with HIV, detected via cardiovascular magnetic resonance.
  • These abnormalities, including ventricular thickening and inflammation, may indicate early stages of HIVAC.

Purpose of the Study:

  • To explore the significance of asymptomatic myocardial pathology in HIV.
  • To understand early disease on a continuum towards advanced cardiomyopathy.
  • To highlight the need for prospective research in treatment-naïve individuals.

Main Methods:

  • Utilized cardiovascular magnetic resonance (CMR) to assess myocardial abnormalities.
  • Analyzed prevalence and characteristics of asymptomatic cardiac pathology in people with HIV.
  • Compared findings with symptomatic HIVAC cases.

Main Results:

  • Revealed a significant burden of asymptomatic myocardial abnormalities in people living with HIV.
  • Identified abnormalities present even at the time of HIV diagnosis.
  • Observed thickened, inflamed ventricles resembling symptomatic HIVAC.

Conclusions:

  • Asymptomatic HIV-associated myocardial pathology represents an early stage of potential cardiomyopathy.
  • Further prospective research in anti-retroviral therapy-naïve individuals is essential.
  • Improved understanding of early cardiac changes is key to managing HIVAC.

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