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A Comprehensive Review of the Manifestation of Cardiovascular Diseases in HIV Patients
Yozahandy A Abarca1, Bhavya Chadalavada2, Jose R Ceron3
1Internal Medicine, Escuela de Medicina y Ciencias de la Salud, Tecnológico de Monterrey, Mexico City, MEX.
Insights
People living with HIV (PLWH) face increased cardiovascular disease (CVD) risk due to HIV and antiretroviral therapy (ART). Tailored screening and ART management are crucial for mitigating these risks and improving long-term health.
Area of Science:
- Cardiovascular Medicine
- Infectious Diseases
- Pharmacology
Background:
- Antiretroviral therapy (ART) has increased lifespan for people living with HIV (PLWH), shifting mortality towards non-AIDS-related causes like cardiovascular diseases (CVDs).
- HIV infection and ART contribute to vascular dysfunction, fibrosis, and hypercoagulation, exacerbating cardiovascular risk.
- Mechanisms include chronic inflammation, immune dysregulation, and ART-specific effects like dyslipidemia and mitochondrial toxicity.
Purpose of the Study:
- To investigate the mechanisms by which HIV and ART contribute to cardiovascular risk in PLWH.
- To highlight the need for tailored cardiovascular screening and management strategies for PLWH.
- To identify challenges in current clinical guidelines and ART selection for balancing viral control and cardiovascular safety.
Main Methods:
- Comprehensive review of existing literature on HIV, ART, and cardiovascular pathophysiology.
- Analysis of mechanistic insights into vascular endothelial dysfunction, myocardial fibrosis, and hypercoagulation.
- Evaluation of current clinical guidelines, advanced imaging techniques, and emerging biomarkers for cardiovascular risk assessment in PLWH.
Main Results:
- HIV and ART promote subclinical atherosclerosis and increase the risk of acute myocardial infarction in PLWH.
- ART regimens, particularly protease inhibitors and zidovudine, have specific detrimental effects on cardiovascular health.
- Current cardiovascular screening guidelines are insufficient for the unique needs of PLWH.
Conclusions:
- Proactive, tailored cardiovascular screening protocols are urgently needed for PLWH.
- Refining ART regimens to mitigate cardiovascular risks is essential for improving long-term outcomes.
- Enhanced awareness and targeted interventions are critical for managing cardiovascular risks in the HIV population.
Abstract:
The increasing lifespan of people living with HIV (PLWH) due to advancements in antiretroviral therapy (ART) has shifted mortality patterns from AIDS-related to non-AIDS-related causes, notably cardiovascular diseases (CVDs). This review investigates how HIV and ART contribute to vascular endothelial dysfunction, myocardial fibrosis, and hypercoagulation, which significantly exacerbate cardiovascular risk. Mechanistic insights include chronic inflammation and immune dysregulation due to persistent HIV infection and ART-specific effects such as protease inhibitors causing dyslipidemia and zidovudine inducing mitochondrial toxicity leading to cardiomyopathy. ART, while lifesaving, has been implicated in promoting subclinical atherosclerosis and increasing the risk of acute myocardial infarction, further highlighting the need for tailored approaches. The manuscript addresses pressing obstacles, including disparities in healthcare access and the lack of standardized cardiovascular screening guidelines specific to PLWH. It emphasizes the integration of advanced imaging techniques and emerging biomarkers, such as coronary artery calcium scoring and soluble ST2, to detect early subclinical cardiovascular abnormalities. The review also identifies challenges in ART selection to balance virologic control and cardiovascular safety. What sets this review apart is its holistic and detailed approach to the intersection of HIV and cardiovascular health. It not only elucidates complex pathophysiological mechanisms but also offers actionable insights into how current clinical guidelines fall short. This manuscript underscores the urgency of implementing proactive cardiovascular screening protocols tailored for PLWH and refining ART regimens to mitigate CVD risks. By addressing these gaps, this work aims to expand our understanding of HIV-related cardiovascular manifestations and provide a foundation for targeted interventions, thereby improving long-term health outcomes for PLWH. This comprehensive perspective is poised to transform clinical practice by fostering greater awareness among physicians and encouraging the development of more effective strategies for managing cardiovascular risks in the HIV population.
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