Cardiac dysfunction in HIV: Etiology, pathophysiology, and future directions

The advent of highly active antiretroviral treatment (HAART) has turned human immunodeficiency virus (HIV) from an acute, high mortality illness to a chronic, treatable disease. While people living with HIV are expected to have a normal life expectancy, this puts HIV infected individuals at risk of developing HIV- associated chronic diseases which includes cardiovascular disease. HIV-associated heart disease may lead to HIV associated cardiomyopathy (HIV CM), which mostly includes heart failure with reduced ejection fraction (HFrEF). There has also been growing evidence of diastolic dysfunction leading to heart failure with preserved ejection fraction (HFpEF) as part of HIV CM. While the underlying etiology for HIV CM has yet to be elicited, the proposed mechanisms include chronic low-grade inflammation, opportunistic infections, direct viral invasion of the myocardium and pericardium, and toxicity from HAART regimens. This review will serve to discuss potential immune and inflammatory mechanisms of HIV CM, the effects of certain HAART on cardiac function, as well as future directions in the work up and evaluation of HIV CM in people living with HIV.