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

Youssef A Elnabawi1, Farzad Marashi2, Norman N Aiad1

  • 1New York University School of Medicine, NY, USA.

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|April 22, 2026
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Summary

Highly active antiretroviral treatment (HAART) has improved human immunodeficiency virus (HIV) outcomes, but increases the risk of HIV-associated cardiomyopathy. This review explores immune mechanisms and HAART effects on cardiac function in people with HIV.

Keywords:
CardiomyopathyHAARTHIV

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Area of Science:

  • Cardiology
  • Infectious Diseases
  • Immunology

Background:

  • Highly active antiretroviral treatment (HAART) has transformed human immunodeficiency virus (HIV) infection into a chronic condition with normal life expectancy.
  • This shift increases the risk of chronic comorbidities, notably cardiovascular disease and HIV-associated cardiomyopathy (HIV-CM).
  • HIV-CM can manifest as heart failure with reduced ejection fraction (HFrEF) or diastolic dysfunction leading to heart failure with preserved ejection fraction (HFpEF).

Purpose of the Study:

  • To review the potential immune and inflammatory mechanisms underlying HIV-associated cardiomyopathy.
  • To discuss the impact of specific HAART regimens on cardiac function.
  • To outline future directions for the evaluation and management of HIV-CM in people living with HIV.

Main Methods:

  • Literature review focusing on immune activation, inflammation, viral factors, and antiretroviral drug toxicity in HIV-CM.
  • Analysis of studies investigating the relationship between HAART and cardiovascular outcomes.
  • Synthesis of current understanding and identification of research gaps.

Main Results:

  • Proposed mechanisms for HIV-CM include chronic inflammation, opportunistic infections, direct viral effects on the heart, and HAART-related cardiotoxicity.
  • Evidence suggests certain HAART regimens may influence cardiac function and increase cardiovascular risk.
  • The precise etiology of HIV-CM remains multifactorial and requires further elucidation.

Conclusions:

  • HIV-CM is a significant concern in the era of effective HIV treatment, necessitating a comprehensive understanding of its pathogenesis.
  • Further research is crucial to differentiate between HIV-related and traditional cardiovascular risk factors and to optimize cardiac care for people with HIV.
  • Personalized approaches to HAART and cardiac monitoring may be essential for preventing and managing HIV-CM.