Mabel Toribio1, Tomas G Neilan2, Markella V Zanni3. 1. Metabolism Unit, Endocrine Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, 5 LON 207, Boston, MA, 02114, USA. 2. Cardiac MR PET CT Program, Division of Cardiology and Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. 3. Metabolism Unit, Endocrine Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, 5 LON 207, Boston, MA, 02114, USA. mzanni@mgh.harvard.edu.
Abstract
PURPOSE: People with HIV (PHIV) with access to modern antiretroviral therapy (ART) face a two-fold increased risk of heart failure as compared with non-HIV-infected individuals. The purpose of this review is to consider evolving risks, mechanisms, and preventive considerations pertaining to heart failure among PHIV. RECENT FINDINGS: While unchecked HIV/AIDS has been documented to precipitate heart failure characterized by overtly reduced cardiac contractile function, ART-treated HIV may be associated with either heart failure with reduced ejection fraction (HFrEF) or with heart failure with preserved ejection fraction (HFpEF). In HFpEF, a "stiff" left ventricle cannot adequately relax in diastole-a condition known as diastolic dysfunction. Diastolic dysfunction, in turn, may result from processes including myocardial fibrosis (triggered by hypertension and/or immune activation/inflammation) and/or myocardial steatosis (triggered by metabolic dysregulation). Notably, hypertension, systemic immune activation, and metabolic dysregulation are all common conditions among even those PHIV who are well-treated with ART. Of clinical consequence, HFpEF is uniquely intransigent to conventional medical therapies and portends high morbidity and mortality. However, diastolic dysfunction is reversible-as are contributing processes of myocardial fibrosis and myocardial steatosis. Our challenges in preserving myocardial health among PHIV are two-fold. First, we must continue working to realize UNAIDS 90-90-90 goals. This achievement will reduce AIDS-related mortality, including cardiovascular deaths from AIDS-associated heart failure. Second, we must work to elucidate the detailed mechanisms continuing to predispose ART-treated PHIV to heart failure and particularly HFpEF. Such efforts will enable the development and implementation of targeted preventive strategies.
PURPOSE:People with HIV (PHIV) with access to modern antiretroviral therapy (ART) face a two-fold increased risk of heart failure as compared with non-HIV-infected individuals. The purpose of this review is to consider evolving risks, mechanisms, and preventive considerations pertaining to heart failure among PHIV. RECENT FINDINGS: While unchecked HIV/AIDS has been documented to precipitate heart failure characterized by overtly reduced cardiac contractile function, ART-treated HIV may be associated with either heart failure with reduced ejection fraction (HFrEF) or with heart failure with preserved ejection fraction (HFpEF). In HFpEF, a "stiff" left ventricle cannot adequately relax in diastole-a condition known as diastolic dysfunction. Diastolic dysfunction, in turn, may result from processes including myocardial fibrosis (triggered by hypertension and/or immune activation/inflammation) and/or myocardial steatosis (triggered by metabolic dysregulation). Notably, hypertension, systemic immune activation, and metabolic dysregulation are all common conditions among even those PHIV who are well-treated with ART. Of clinical consequence, HFpEF is uniquely intransigent to conventional medical therapies and portends high morbidity and mortality. However, diastolic dysfunction is reversible-as are contributing processes of myocardial fibrosis and myocardial steatosis. Our challenges in preserving myocardial health among PHIV are two-fold. First, we must continue working to realize UNAIDS 90-90-90 goals. This achievement will reduce AIDS-related mortality, including cardiovascular deaths from AIDS-associated heart failure. Second, we must work to elucidate the detailed mechanisms continuing to predispose ART-treated PHIV to heart failure and particularly HFpEF. Such efforts will enable the development and implementation of targeted preventive strategies.
Authors: Markella V Zanni; Magid Awadalla; Mabel Toribio; Jake Robinson; Lauren A Stone; Diana Cagliero; Adam Rokicki; Connor P Mulligan; Jennifer E Ho; Anne M Neilan; Mark J Siedner; Virginia A Triant; Takara L Stanley; Lidia S Szczepaniak; Michael Jerosch-Herold; Michael D Nelson; Tricia H Burdo; Tomas G Neilan Journal: J Infect Dis Date: 2020-03-28 Impact factor: 5.226
Authors: Jason S Reingold; Jonathan M McGavock; Shaheen Kaka; Tommy Tillery; Ronald G Victor; Lidia S Szczepaniak Journal: Am J Physiol Endocrinol Metab Date: 2005-06-21 Impact factor: 4.310
Authors: Markella V Zanni; Mabel Toribio; Moses Q Wilks; Michael T Lu; Tricia H Burdo; Joshua Walker; Patrick Autissier; Borek Foldyna; Lauren Stone; Amanda Martin; Fred Cope; Bonnie Abbruzzese; Thomas Brady; Udo Hoffmann; Kenneth C Williams; Georges El-Fakhri; Steven K Grinspoon Journal: J Infect Dis Date: 2017-04-15 Impact factor: 5.226
Authors: Jennifer E Ho; Danielle Enserro; Frank P Brouwers; Jorge R Kizer; Sanjiv J Shah; Bruce M Psaty; Traci M Bartz; Rajalakshmi Santhanakrishnan; Douglas S Lee; Cheeling Chan; Kiang Liu; Michael J Blaha; Hans L Hillege; Pim van der Harst; Wiek H van Gilst; Willem J Kop; Ron T Gansevoort; Ramachandran S Vasan; Julius M Gardin; Daniel Levy; John S Gottdiener; Rudolf A de Boer; Martin G Larson Journal: Circ Heart Fail Date: 2016-06 Impact factor: 8.790
Authors: Tomas G Neilan; Kim-Lien Nguyen; Vlad G Zaha; Kara W Chew; Leavitt Morrison; Ntobeko A B Ntusi; Mabel Toribio; Magid Awadalla; Zsofia D Drobni; Michael D Nelson; Tricia H Burdo; Marije Van Schalkwyk; Paul E Sax; Daniel J Skiest; Karen Tashima; Raphael J Landovitz; Eric Daar; Alysse G Wurcel; Gregory K Robbins; Robert K Bolan; Kathleen V Fitch; Judith S Currier; Gerald S Bloomfield; Patrice Desvigne-Nickens; Pamela S Douglas; Udo Hoffmann; Steven K Grinspoon; Heather Ribaudo; Rodney Dawson; Matthew Bidwell Goetz; Mamta K Jain; Alberta Warner; Lidia S Szczepaniak; Markella V Zanni Journal: J Infect Dis Date: 2020-07-09 Impact factor: 5.226
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: Mabel Toribio; Magid Awadalla; Madeline Cetlin; Evelynne S Fulda; Takara L Stanley; Zsofia D Drobni; Lidia S Szczepaniak; Michael D Nelson; Michael Jerosch-Herold; Tricia H Burdo; Tomas G Neilan; Markella V Zanni Journal: J Acquir Immune Defic Syndr Date: 2020-10-01 Impact factor: 3.731
Authors: Mabel Toribio; Evelynne S Fulda; Sarah M Chu; Zsofia D Drobni; Magid Awadalla; Madeline Cetlin; Takara L Stanley; Crystal M North; Michael D Nelson; Michael Jerosch-Herold; Lidia S Szczepaniak; Tricia H Burdo; Sara E Looby; Tomas G Neilan; Markella V Zanni Journal: Open Forum Infect Dis Date: 2021-01-12 Impact factor: 3.835