title: Human Immunodeficiency Virus and Heart Failure in Low- and Middle-Income Countries.
abstract: Successful combination therapy for human immunodeficiency virus (HIV) has transformed this disease from a short-lived infection with high mortality to a chronic disease associated with increasing life expectancy. This is true for high- as well as low- and middle-income countries. As a result of this increased life expectancy, people living with HIV are now at risk of developing other chronic diseases associated with aging. Heart failure has been common among people living with HIV in the eras of pre- and post- availability of antiretroviral therapy; however, our current understanding of the pathogenesis and approaches to management have not been systematically addressed. HIV may cause heart failure through direct (e.g., viral replication, mitochondrial dysfunction, cardiac autoimmunity, autonomic dysfunction) and indirect (e.g., opportunistic infections, antiretroviral therapy, alcohol abuse, micronutrient deficiency, tobacco use) pathways. In low- and middle-income countries, 2 large observational studies have recently reported clinical characteristics and outcomes in these patients. HIV-associated heart failure remains a common cardiac diagnosis in people living with heart failure, yet a unifying set of diagnostic criteria is lacking. Treatment patterns for heart failure fall short of society guidelines. Although there may be promise in cardiac glycosides for treating heart failure in people living with HIV, clinical studies are needed to validate in vitro findings. Owing to the burden of HIV in low- and middle-income countries and the concurrent rise of traditional cardiovascular risk factors, strategic and concerted efforts in this area are likely to impact the care of people living with HIV around the globe.
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina; Duke Global Health Institute, Duke University Medical Center, Durham, North Carolina. Electronic address: gerald.bloomfield@duke.edu.
authors.forename: Gerald S
authors.initials: GS
authors.lastname: Bloomfield
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, North Carolina.
authors.forename: Fawaz
authors.initials: F
authors.lastname: Alenezi
authors.affiliation: Division of Medicine, Moi Teaching and Referral Hospital, Eldoret, Kenya.
authors.forename: Felix A
authors.initials: FA
authors.lastname: Barasa
authors.affiliation: School of Medicine, University of Massachusetts, Worcester, Massachusetts.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Lumsden
authors.affiliation: Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa.
authors.forename: Bongani M
authors.initials: BM
authors.lastname: Mayosi
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina; Duke Global Health Institute, Duke University Medical Center, Durham, North Carolina.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Velazquez
mesh_terms: D000367:Age Factors; D023241:Antiretroviral Therapy, Highly Active; D002423:Cause of Death; D002908:Chronic Disease / Q000453:epidemiology / Q000401:mortality; D003430:Cross-Sectional Studies; D019049:Developed Countries; D003906:Developing Countries; D005544:Forecasting; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D006333:Heart Failure / Q000453:epidemiology* / Q000401:mortality; D006801:Humans; D038622:Internationality; D008017:Life Expectancy / Q000639:trends; D012307:Risk Factors
keywords: developing countries; heart failure; human immunodeficiency virus