HIV Infection and Risk of Cardiovascular Diseases Beyond Coronary Artery Disease.
OBJECTIVE
Cardiovascular disease (CVD) increasingly afflicts people living with HIV (PLWH) in the contemporary era of antiretroviral therapy (ART). Coronary artery disease (CAD) is the most widely studied cardiovascular problem in PLWH; however, less is known about other clinically relevant subtypes of CVD such as heart failure (HF), cerebrovascular disease, sudden cardiac death, pericardial diseases, and pulmonary hypertension. This paper reviews evidence of other subtypes of CVD as emerging issues in the post-ART era.


RESULTS
Recent studies have shown that PLWH have higher risk of HF as well as subclinical impairment of left ventricular (LV) mechanics (systolic and diastolic dysfunction) and myocardial abnormalities (fibrosis and steatosis). The underlying mechanisms, however, are not well-understood. A few studies have also shown higher rates of atrial fibrillation and sudden cardiac death in PLWH. Ischemic stroke is the most common stroke type in the post-ART era, with underlying mechanisms like those identified in CAD: chronic inflammation and associated vasculopathy. Studies of great vessels (carotid artery and aorta) and peripheral arterial disease show heterogeneous results. Small subclinical pericardial effusions are common in PLWH in post-ART era. Pulmonary hypertension continues to be an underdiagnosed and potentially fatal complication of HIV infection. PLWH remain at higher risk for all types of CVD including heart failure, stroke, and arrhythmias in the post-ART era. Chronic inflammation may play an important role in this increased risk. More studies are needed to further elucidate the extent of non-coronary CVD in PLWH and the underlying mechanisms for them.
Department of Family Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
Revery P
RP
Barnes
Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
John Charles A
JC
Lacson
Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA. hbahrami@med.usc.edu.|Division of Cardiovascular Medicine, Department of Medicine, University of Southern California, Los Angeles, CA, USA. hbahrami@med.usc.edu.|Department of Radiology, Keck School of Medicine, University of Southern California, 2020 Zonal Ave, Los Angeles, CA, 90033, USA. hbahrami@med.usc.edu.
Hossein
H
Bahrami
D002318:Cardiovascular Diseases / Q000150:complications / Q000821:virology*; D015658:HIV Infections / Q000150:complications* / Q000503:physiopathology; D006801:Humans; D012306:Risk
Atrial fibrillation; Cardiovascular disease; HIV infection; Heart failure; Stroke; Sudden cardiac death