Cardiomyopathy and Heart Failure in Patients with Human Immunodeficiency Virus Infection

Publication date: Available online 19 October 2018Source: Canadian Journal of CardiologyAuthor(s): Panagiotis Savvoulidis, Javed Butler, Andreas KalogeropoulosAbstractWith the advent and widespread use of antiretroviral therapy (ART), the epidemiology of cardiomyopathy and heart failure (HF) associated with human immunodeficiency virus (HIV) infection is changing. Near-normal life expectancy in contemporary HIV-infected populations has been associated with prolonged exposure to increased cardiometabolic burden and chronic immune activation and systemic inflammation. Therefore, the pre-ART phenotype of HIV-associated cardiomyopathy with overt left ventricular systolic dysfunction and poor prognosis has been replaced over time by cardiomyopathy with a more insidious course, more frequent ischemic background, and highly prevalent left ventricular diastolic dysfunction. Patients with HIV are more prone to development of coronary artery disease and development of HF after myocardial infarction. The role of ongoing immune activation and systemic inflammation, despite highly-active ART (HAART), appears to be central in this process. The role of HAART toxicity is controversial, as HAART itself appears to be protective for the development of HF, but recent data suggest that protease inhibitors may adversely affect the course of HIV-associated heart failure. Because of these unique features, the optimal therapeutic approach for HIV-associated cardiomyopathy remains unknown. The current...

Source: Canadian Journal of Cardiology - October 20, 2018 Category: Cardiology Source Type: research