title: HIV and noncommunicable cardiovascular and pulmonary diseases in low- and middle-income countries in the ART era: what we know and best directions for future research.
abstract: With the advent of effective antiretroviral therapy (ART), HIV is becoming a chronic disease. HIV-seropositive (+) patients on ART can expect to live longer and, as a result, they are at risk of developing chronic noncommunicable diseases related to factors, such as aging, lifestyle, long-term HIV infection, and the potential adverse effects of ART. Although data are incomplete, evidence suggests that even in low- and middle-income countries (LMICs), chronic cardiovascular and pulmonary diseases are increasing in HIV-positive patients. This review summarizes evidence-linking HIV infection to the most commonly cited chronic cardiovascular and pulmonary conditions in LMICs: heart failure, hypertension, coronary artery disease/myocardial infarction, stroke, obstructive lung diseases, and pulmonary arterial hypertension. We describe the observed epidemiology of these conditions, factors affecting expression in LMICs, and key populations that may be at higher risk (ie, illicit drug users and children), and finally, we suggest that strategic areas of research and training intended to counter these conditions effectively. As access to ART in LMICs increases, long-term outcomes among HIV-positive persons will increasingly be determined by a range of associated chronic cardiovascular and pulmonary complications. Actions taken now to identify those conditions that contribute to long-term morbidity and mortality optimize early recognition and diagnosis and implement effective prevention strategies and/or disease interventions are likely to have the greatest impact on limiting cardiovascular and pulmonary disease comorbidity and improving population health among HIV-positive patients in LMICs.
authors.affiliation: *Division of Cardiology, Department of Medicine and Duke Clinical Research Institute, Duke University, Durham, NC; †Duke Global Health Institute, Duke University, Durham, NC; ‡Departments of Medicine and Immunology, University of Pittsburgh School of Medicine, Pittsburgh, PA; §National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD; ‖Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom; ¶Malawi-Liverpool-Wellcome Major Overseas Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi; #Divisions of Pulmonary and Critical Care Medicine; and **Infectious Diseases, Department of Medicine, Duke University, Durham, NC.
authors.forename: Gerald S
authors.initials: GS
authors.lastname: Bloomfield
authors.forename: Prateeti
authors.initials: P
authors.lastname: Khazanie
authors.forename: Alison
authors.initials: A
authors.lastname: Morris
authors.forename: Cristina
authors.initials: C
authors.lastname: Rabadán-Diehl
authors.forename: Laura A
authors.initials: LA
authors.lastname: Benjamin
authors.forename: David
authors.initials: D
authors.lastname: Murdoch
authors.forename: Virginia S
authors.initials: VS
authors.lastname: Radcliff
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Velazquez
authors.forename: Charles
authors.initials: C
authors.lastname: Hicks
mesh_terms: D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D003906:Developing Countries; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology*; D006801:Humans; D008171:Lung Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D012106:Research; D012307:Risk Factors
chemical_list: D044966:Anti-Retroviral Agents