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

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.