Epidemiology, pathophysiology, and prevention of heart failure in people with HIV

Prog Cardiovasc Dis. Mar-Apr 2020;63(2):134-141. doi: 10.1016/j.pcad.2020.01.002. Epub 2020 Jan 24.

Abstract

Heart failure (HF) has been a known complication of HIV/AIDS for three decades. As the treatment of HIV has changed, so has the epidemiology and pathophysiology of HF in people with HIV (PWH). Initial manifestations of HF in uncontrolled HIV primarily included a rapidly evolving cardiomyopathy with pericardial involvement. With the widespread uptake of effective antiretroviral therapy (ART), HF in PWH has become a chronic disease reflective of the aging population and associated comorbidities, albeit with a contribution from HIV-associated chronic immune dysregulation and inflammation. Despite viral suppression, PWH remain at elevated risk for both HF with reduced ejection fraction and HF with preserved ejection fraction. In this review, we discuss the changing epidemiology and mechanisms of HF in PWH and how that may inform HF prevention in this vulnerable population.

Keywords: HIV; Heart failure; Immune dysfunction.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Anti-HIV Agents / adverse effects
  • Anti-HIV Agents / therapeutic use*
  • HIV Infections / drug therapy*
  • HIV Infections / epidemiology
  • HIV Infections / immunology
  • HIV Long-Term Survivors*
  • Health Status
  • Heart Failure / epidemiology
  • Heart Failure / immunology
  • Heart Failure / physiopathology
  • Heart Failure / prevention & control*
  • Humans
  • Immunocompromised Host
  • Preventive Health Services*
  • Prognosis
  • Protective Factors
  • Risk Assessment
  • Risk Factors
  • Viral Load

Substances

  • Anti-HIV Agents