Heart Failure among People with HIV: Evolving Risks, Mechanisms, and Preventive Considerations

AbstractPurposePeople 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 FindingsWhile 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 (triggere d 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 mor bidity and mortality. However, diastolic dysfunction is reversible—as are contributing processes of myocardial fibrosis and myocardial steatosis.SummaryOur challenges in preserving myocardial health among PHIV are two-fold. First, we must continu...
Source: Current HIV/AIDS Reports - Category: Infectious Diseases Source Type: research