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Large lessons learned from small vessels: coronary microvascular dysfunction in HIV

Teressa S Thomas1, Allie R Walpert, Suman Srinivasa

  • 1Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.

Current Opinion in Infectious Diseases
|October 27, 2023
PubMed

Insights

Coronary microvascular dysfunction (CMD) is common in people with HIV (PWH), increasing heart failure risk. This condition affects PWH even with well-managed HIV and may be worse in women.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Vascular Biology

Background:

  • Heart failure risk is elevated in people with HIV (PWH).
  • Early research focused on large vessel disease in HIV, but recent studies highlight small vessel disease, or coronary microvascular dysfunction (CMD).
  • CMD is a significant risk factor for heart failure and cardiovascular mortality, often occurring without significant atherosclerotic disease.

Approach:

  • This review synthesizes current understanding of CMD in the context of HIV.
  • It examines the role of inflammation and endothelial dysfunction in CMD pathogenesis.
  • Clinical studies and implications for PWH are discussed.

Key Points:

  • CMD is increasingly recognized in PWH, contributing to heart failure.
  • Inflammation and endothelial dysfunction are potential drivers of CMD in HIV.
  • CMD may worsen with antiretroviral therapy (ART) initiation but is also present in well-treated PWH.
  • Myocardial flow reserve (MFR), a marker for CMD, is reduced in PWH, similar to individuals with diabetes.
  • Women with HIV may experience more severe CMD than men.

Conclusions:

  • Alterations in the coronary microvasculature are a key factor in subclinical myocardial dysfunction among PWH.
  • CMD warrants further clinical investigation in PWH, particularly those without diagnosed cardiovascular disease.
Abstract

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