Individuals living with HIV are at an increased risk for cardiovascular diseases, such as myocardial infarction, heart failure, and sudden cardiac death, among others.
A literature review published by Clinical Microbiology Reviews presents a detailed examination of the clinical and mechanistic evidence linking HIV with increased cardiovascular risk, discusses the implications for various cardiovascular disease (CVD) manifestations in people with HIV (PWH), and provides contemporary recommendations for cardiovascular risk management in the context of current research.
A major underlying cause of increased CVD in HIV-positive individuals is chronic immune dysregulation, leading to persistent inflammation, especially notable in patients with prolonged viremia and impaired CD4+ T cell recovery. This inflammatory state, compounded by prevalent comorbidities like dyslipidemia and smoking, along with potential adverse effects from antiretroviral therapy, significantly contributes to the elevated incidence of CVDs in this population.
Cardiovascular Risks in HIV: Gaps in Current Understanding and Management
Individuals with HIV face a higher risk of CVDs, including myocardial infarction, stroke, heart failure, and sudden death, compared to those without HIV. The specific mechanisms behind these increased risks, particularly for heart failure and sudden cardiac death, are not fully understood and largely derived from studies in high-income countries, highlighting a significant knowledge gap for the global HIV population.
This gap may hold important implications for controlling cardiovascular pathologies in HIV patients. For example, the immunologic impacts of HIV from perinatal infection (which is considerably more common in areas with relatively high HIV endemicity) on atherothrombotic and myocardial disease may differ significantly from those of HIV acquired at middle age or later.
Currently, prolonged viremia and a low CD4 count, whether present or past, are linked to an increased risk of CVDs in PWH. Managing this risk involves prompt and ongoing antiretroviral therapy to control HIV and improve CD4 counts.
Also, lipid-lowering therapies, such as statins seem to provide athero-protective benefits for people with HIV, suggesting a potential for lower clinical thresholds for their use in this population.
The evolving nature of HIV with new long-acting treatments and the diverse immune responses influenced by factors like age and infection duration necessitate further research. This is particularly true as the demographics of the HIV population change, with an increasing number of individuals living into older age, especially in regions like sub-Saharan Africa.
Indications for Future Research
Further studies focusing on the etiologies and mechanisms of HIV-associated heart conditions are needed to improve screening, prevention, and treatment strategies. With the landscape of HIV-associated cardiovascular diseases continuously changing, ongoing clinical research and surveillance are vital for effectively adapting approaches to prevention and management.
Source:
Nazari, I., & Feinstein, M. J. (2024). Evolving mechanisms and presentations of cardiovascular disease in people with HIV: implications for management. Clinical Microbiology Reviews, 37(1), e0009822. https://doi.org/10.1128/cmr.00098-22
