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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.
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EPIDEMIOLOGY OF HIV/AIDS
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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).
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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 13 million children have been orphaned and approximately two-thirds of the global HIV/AIDS burden exists.3 More than 2.4 million people have been infected by HIV in North America and Europe, although many are still unaware of their infectious status.4 Prevention strategies may have helped reduce HIV prevalence rates in some countries where HIV infection may be on the decline,5 and it is estimated that up to 15 million people worldwide are now accessing antiretroviral therapy.2,5
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Many cultural and social factors impact demographic patterns of HIV/AIDS.6,7 In the United States and northern Europe, HIV had predominantly involved MSM, although heterosexual transmission now is the dominant route of infection.8,9,10,11,12 In Southern and Eastern Europe, Vietnam, Malaysia, Northeast India, and China the incidence has been greatest in injection drug users. However, in Africa, the Caribbean, and much of Southeast Asia, the dominant route of transmission has been heterosexual or vertical from mother to child, reflecting the high global proportion of relatively young women with HIV.13
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NATURAL HISTORY AND BIOLOGY OF HIV/AIDS
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HIV-1 is a single-stranded RNA retrovirus from the Lentivirus family that invades cells containing specific membrane receptors and incorporates a DNA copy of itself into the host’s genome. Immune deficiency is the result of viral and immune-mediated destruction of CD4+ lymphocytes caused by continuous high-level HIV-1 replication. The reduction ...