Priscilla Y Hsue1, David D Waters. 1. aDivision of Cardiology, UCSF at Zuckerberg San Francisco General Hospital bDepartment of Medicine, University of California, San Francisco, California, USA.
Abstract
PURPOSE OF REVIEW: To discuss presentation, pathophysiology, complications, and treatment of heart failure in persons living with HIV (PLWHIV) in the antiretroviral therapy (ART) era. RECENT FINDINGS: Since the advent of effective ART and improved longevity, heart failure has become more chronic and insidious and is often characterized by preserved ejection fraction, diastolic dysfunction, and left ventricular (LV) hypertrophy. The mechanism underlying heart failure in the setting of HIV infection remains unknown. A high burden of coronary risk factors is often present in PLWHIV, and clinical manifestations of coronary disease appear at a younger age compared with uninfected persons. Heart failure is more common in the year following myocardial infarction in HIV-infected compared with uninfected patients. Epidemiological data suggest the incidence of atrial fibrillation in PLWHIV is increasing, likely due to advancing age and increasing rates of LV hypertrophy in this population. The treatment of heart failure in PLWHIV is extrapolated from treatment of uninfected patients, as clinical trials have not been done specifically in HIV. SUMMARY: Symptoms of heart failure or echocardiographic evidence of cardiomyopathy increase the risk of death in PLWHIV. Additional studies are needed to ascertain if HIV-specific issues such as newer ART, chronic inflammation/immune activation, illicit drug use, and early initiation of ART are implicated in heart failure pathogenesis.
PURPOSE OF REVIEW: To discuss presentation, pathophysiology, complications, and treatment of heart failure in persons living with HIV (PLWHIV) in the antiretroviral therapy (ART) era. RECENT FINDINGS: Since the advent of effective ART and improved longevity, heart failure has become more chronic and insidious and is often characterized by preserved ejection fraction, diastolic dysfunction, and left ventricular (LV) hypertrophy. The mechanism underlying heart failure in the setting of HIV infection remains unknown. A high burden of coronary risk factors is often present in PLWHIV, and clinical manifestations of coronary disease appear at a younger age compared with uninfected persons. Heart failure is more common in the year following myocardial infarction in HIV-infected compared with uninfected patients. Epidemiological data suggest the incidence of atrial fibrillation in PLWHIV is increasing, likely due to advancing age and increasing rates of LV hypertrophy in this population. The treatment of heart failure in PLWHIV is extrapolated from treatment of uninfected patients, as clinical trials have not been done specifically in HIV. SUMMARY: Symptoms of heart failure or echocardiographic evidence of cardiomyopathy increase the risk of death in PLWHIV. Additional studies are needed to ascertain if HIV-specific issues such as newer ART, chronic inflammation/immune activation, illicit drug use, and early initiation of ART are implicated in heart failure pathogenesis.
Authors: Jennifer O Lam; Wendy A Leyden; Thomas K Leong; Michael A Horberg; Kristi Reynolds; Andrew P Ambrosy; Harshith R Avula; Rulin C Hechter; William J Towner; Suma Vupputuri; Alan S Go; Michael J Silverberg Journal: J Acquir Immune Defic Syndr Date: 2022-10-01 Impact factor: 3.771
Authors: John M Abbamonte; Nicholas V Cristofari; Stephen M Weiss; Mahendra Kumar; Dushyantha T Jayaweera; Deborah L Jones Journal: AIDS Behav Date: 2021-02
Authors: Violeta J Rodriguez; Antonio Chahine; Manasi S Parrish; Maria L Alcaide; Tae Kyoung Lee; Barry Hurwitz; Manisha Sawhney; Stephen M Weiss; Deborah L Jones; Mahendra Kumar Journal: AIDS Care Date: 2020-05-13
Authors: Prasanta K Dash; Fadhel A Alomar; Bryan T Hackfort; Hang Su; Amy Conaway; Larisa Y Poluektova; Howard E Gendelman; Santhi Gorantla; Keshore R Bidasee Journal: Sci Rep Date: 2020-06-16 Impact factor: 4.379