ReviewCardiovascular disease in patients with chronic human immunodeficiency virus infection
Introduction
In 2012, the United Nations (UN) estimated that globally, 34 million people were living with human immunodeficiency virus (HIV) infection at the end of 2011. The same report estimated that 1.7 million people died from acquired immunodeficiency syndrome (AIDS)-related causes worldwide. This represents a 24% decline in AIDS-related mortality compared with 2005 (when 2.3 million deaths occurred) [1] About 6.5% of AIDS-related mortality is attributable to cardiovascular disease [2].
In the United States, over half of all HIV-infected individuals will be over the age of 50 years by 2015 [3]. It is evident that advancing age, resulting from prolonged life expectancy, and a higher prevalence of traditional risk factors remain important contributors to cardiovascular disease (CVD) risk in these patients. However, HIV-specific factors are also pro-atherogenic, both as a consequence of antiretroviral drug toxicity and HIV infection itself perhaps due to inflammation and immune dysfunction [4]. Immune dysfunction, activation of lymphocytes, and inflammation are hallmarks of HIV infection that may play a pivotal role in the development of early CVD [5]. In fact, literature suggests that patients with chronic inflammatory diseases are at increased risk for the development of CVD [6]. In this particular group of patients atherosclerosis is the most common cardiac abnormality, although lesions of the valves, myocardium and pericarditis may all occur [7].
The purpose of this review is to explore the cardiovascular disease states induced by HIV infection and its therapy such as HIV-related cardiomyopathy, conduction system disease, and coronary heart disease.
Section snippets
Coronary artery disease
In several cohorts, the mean age at which MI occurred in HIV infected patients was lower than 50 years of age, [8], far less than that reported in the general population. However, the median age of the HIV population is also far less than that of the general population, leading to a younger age at diagnosis of MI [9]. It is evident that patients infected with HIV are at higher risk for CAD compared with the age-matched general population [10]. Several studies have suggested that among patients
Antiretroviral therapies for HIV
It has now been over 25 years since the approval of zidovudine (AZT) as the first antiretroviral agent for HIV. Since that time, there have been dramatic advances in the efficacy, tolerability, potency, and availability of highly active antiretroviral therapy (HAART). Now, combination antiretroviral therapy (cART) with multiple agents has become the standard of care for HIV infected individuals [58], [59]. Current classes of antiretroviral agents are as follows: nucleoside reverse transcriptase
References (79)
- et al.
HIV and coronary heart disease: time for better understanding
J Am Coll Cardiol
(2013) - et al.
HIV and coronary heart disease: time for a better understanding
J Am Coll Cardiol
(2013) - et al.
Significant coronary stenosis detected by coronary computed angiography in asymptomatic HIV infected subjects
J Infect
(2012) - et al.
Clinical presentation of acute coronary syndrome in HIV infected adults: a retrospective analysis of a prospectively collected cohort
Eur J Intern Med
(2011) - et al.
Angiographic features and cardiovascular risk factors in human immunodeficiency virus-infected patients with first-time acute coronary syndrome
Am J Cardiol
(2013) - et al.
Coronary atherosclerotic lesions in human immunodeficiency virus-infected patients: a histopathologic study
Cardiovasc Pathol
(2009) - et al.
Effects of infection and inflammation on lipid and lipoprotein metabolism: mechanisms and consequences to the host
J Lipid Res
(2004) - et al.
Insulin resistance, chronic inflammatory state and the link with systemic lupus erythematosus-related coronary disease
Autoimmun Rev
(2006) - et al.
Comparison of outcomes using bare metal versus drug-eluting stents in coronary artery disease patients with and without human immunodeficiency virus infection
Am J Cardiol
(2009) - et al.
Cardiac involvement by Kaposi's sarcoma in acquired immune deficiency syndrome (AIDS)
Am J Cardiol
(1984)
Reversibility of cardiac abnormalities in human immunodeficiency virus (HIV)-infected individuals: a serial echocardiographic study
J Am Coll Cardiol
Human immunodeficiency virus infection and left ventricular assist devices: a case series
J Heart Lung Transplant
Heart transplantation in human immunodeficiency virus-positive patients
J Heart Lung Transplant
Inotropic contractile reserve can risk-stratify patients with HIV cardiomyopathy: a dobutamine stress echocardiography study
JACC Cardiovasc Imaging
Prognostic associations of Minnesota Code serial electrocardiographic change classification with coronary heart disease mortality in the Multiple Risk Factor Intervention Trial
Am J Cardiol
Prevalence and prognostic significance of ECG abnormalities in HIV-infected patients: results from the Strategies for Management of Antiretroviral Therapy study
J Electrocardiol
Current burden of sudden cardiac death: multiple source surveillance versus retrospective death certificate-based review in a large U.S. community
J Am Coll Cardiol
Sudden cardiac death in patients with human immunodeficiency virus infection
J Am Coll Cardiol
Relation of subepicardial adipose tissue to carotid intima-media thickness in patients with human immunodeficiency virus
Am J Cardiol
Smoking cessation
Clin Chest Med
UNAIDS report on the global AIDS epidemic
Causes of death in HIV-1-infected patients treated with antiretroviral therapy, 1996–2006: collaborative analysis of 13 HIV cohort studies
Clin Infect Dis
Aging and infectious diseases: workshop on HIV infection and aging: what is known and future research directions
Clin Infect Dis
Risk factors for coronary heart disease in patients treated for human immunodeficiency virus infection compared with the general population
Clin Infect Dis
Inflammatory and coagulation biomarkers and mortality in patients with HIV infection
PLoS Med
Roles of the chemokine system in development of obesity, insulin resistance and cardiovascular disease
J Immunol Res.
Accelerated Atherosclerosis in systemic lupus erythematosus: perspectives towards decreasing cardiovascular morbidity and mortality
Lupus
Ten-year predicted coronary heart disease risk in HIV-infected men and women
Clin Infect Dis
Hypertension in an urban HIV-positive population compared with the general population: influence of combination antiretroviral therapy
J Hypertens
From lipodystrophy and insulin resistance to metabolic syndrome: HIV infection, treatment and aging
Curr Opin HIV AIDS
Hypertension among HIV patients: prevalence and relationships to insulin resistance and metabolic syndrome
J Hypertens
Metabolic syndrome and cardiovascular disease in patients with human immunodeficiency virus
Am J Med
Contribution of genetic background, traditional risk factors, and HIV-related factors to coronary artery disease events in HIV-positive persons
Clin Infect Dis
Acute coronary syndromes in human immunodeficiency virus patients: a meta-analysis investigating adverse event rates and the role of antiretroviral therapy
Eur Heart J
Acute coronary syndrome in human immunodeficiency virus-infected patients: characteristics and 1 year prognosis
Eur Heart J
Increased coronary atherosclerotic plaque vulnerability by coronary computed tomography angiography in HIV-infected men
AIDS
Increased coronary artery calcium score and noncalcified plaque among HIV-infected men: relationship to metabolic syndrome and cardiac risk parameters
J Acquir Immune Defic Syndr
Inflammation, stress, and diabetes
J Clin Invest
Cardiovascular manifestations of HIV infection
Circulation
Cited by (25)
Cardiovascular risk in HIV-infected individuals: A comparison of three risk prediction algorithms
2019, Revista Portuguesa de CardiologiaCitation Excerpt :Traditional risk factors such as smoking, which are particularly prevalent in this population, contribute to this increased risk.1,2,6,11–16 Other factors include substance abuse6 and changes in lipid profile1,8,12,15,17 and glucose metabolism, with increased insulin resistance and/or impaired insulin secretion.8,18 HIV infection itself, as well as inflammation and antiretroviral therapy (ART), are further contributing factors in this population.11
Effect of aspirin treatment on abacavir-associated platelet hyperreactivity in HIV-infected patients
2018, International Journal of CardiologyCitation Excerpt :Nevertheless, recent follow-up reports re-analysing the large D:A:D study have confirmed a consistent increase of the risk of MI associated with ABC use [9,10], and other recent studies have concluded that cumulative exposure to ABC increases cardiovascular ischemic events [11,12]. Therefore, although the overall available evidence on the association of ABC with MI can not be considered as conclusive [13], most treatment guidelines warrant caution in the prescription of this drug in patients with a high cardiovascular risk [14]. Given that the enhanced cardiovascular risk associated with ABC use involves principally MI, a disease condition in the pathogenesis of which platelets play a central role [15], it appears precociously (within 6 months) and is rapidly reversible upon drug suspension [16,17], it seems likely that its mechanism may be linked to a drug-induced enhancement of platelet-dependent coronary thrombus formation rather than to accelerated atherosclerosis.
Promoting Cardiovascular Health in Patients Living with Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome
2018, Nursing Clinics of North AmericaHIV and coronary disease – When secondary prevention is insufficient
2017, Revista Portuguesa de CardiologiaImmune biomarkers of cardiovascular risk in HIV-1 infection
2017, Revista Colombiana de Cardiologia