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Summary

This chapter discusses the cardiovascular effects of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) and the adverse cardiovascular effects of therapy. Prior to highly active antiretroviral therapy (HAART), >6% of HIV/AIDS patients had cardiovascular diseases, but many of these conditions were mild. Since then, with environmental stresses, the toxicities associated with contemporary therapies, and the increased life span that has resulted from the efficacy of contemporary therapies, the spectrum of cardiovascular disease experienced by HIV/AIDS patients has changed (see accompanying Hurst’s Central Illustration). Nonbacterial thrombotic endocarditis is now rarely reported in patients with HIV/AIDS, but pericarditis and myocarditis remain prevalent in the developing world. Both HIV-1 infection itself and HAART may have a negative impact on myocardial function and be involved in the development of HIV/AIDS cardiomyopathy. In developed countries, premature coronary artery disease, metabolic syndrome, and other manifestations of atherosclerosis are emerging as key cardiovascular disorders in the HIV/AIDS patient population. HIV/AIDS patients should be assessed for traditional cardiovascular risk factors that are prevalent in this population irrespective of therapy. Notably, possible cardiovascular drug interactions with HIV/AIDS therapies have been reported.

eFig 102-01

Hurst's Central Illustration: Change in the Spectrum of Cardiovascular Disease Prevalent Among HIV/AIDS Patientsa.

The spectrum of cardiovascular disease prevalent among patients with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) has changed since the development of highly active antiretroviral therapy (HAART).

INTRODUCTION

The human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) has become an important clinical entity in cardiovascular medicine. As a result of behavioral changes and improved therapy, HIV/AIDS patients are surviving longer and the prevalence of cardiovascular diseases in this population now more closely mirrors that of the non-HIV/AIDS population. Key factors in the development of cardiovascular disease in HIV/AIDS are the cardiovascular effects of HIV/AIDS and side effects of therapy, such as highly active antiretroviral therapy (HAART), and it is important to be aware of them.

EPIDEMIOLOGY OF HIV/AIDS

AIDS was first recognized in 1981 and is caused by the human immunodeficiency virus HIV-1.1 HIV-2 causes a similar illness to HIV-1, but is less aggressive and has so far been observed mostly in western Africa. HIV-1 is acquired through exposure to infected body fluids, particularly blood and semen. The commonest modes of spread are sexual (heterosexual or men who have sex with men [MSM]), parenteral (blood or blood product recipients, injection drug users, and occupational exposure to contaminated products), and vertical transmission (mother to fetus).

HIV/AIDS is now the second leading cause of death in the world, with a continuing global prevalence of 0.8%.2 According to the World Health Organization, 35 million people are living with HIV/AIDS, with 2 million new infections and 1.2 million AIDS-related deaths reported in 2014.2 The vast majority of deaths have occurred in sub-Saharan Africa, where over ...

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