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CHAPTER SUMMARY AND CENTRAL ILLUSTRATION
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Chapter Summary
This chapter focuses on current understanding of the pathogenesis and risk factors associated with heart disease in individuals with human immunodeficiency virus (HIV) infection, and discusses relevant advances in diagnosis and management. Heart disease associated with HIV infection encompasses a broad range of manifestations; infection with HIV may lead to involvement of the pericardium, myocardium, coronary arteries, cardiac valves, pulmonary vasculature, as well as the systemic vasculature (see Fuster and Hurst’s Central Illustration). Depending on the level of viral suppression, patients may present with features of pericardial effusion, cardiomyopathy, ischemic heart disease, diastolic left ventricular dysfunction, pulmonary arterial hypertension, infective endocarditis, and manifestations of thrombotic events in the systemic or venous circulation. The availability of healthcare resources and combined antiretroviral therapy has had a major impact on both the prevalence and severity of cardiovascular disease as well as on short- and long-term outcomes. As many HIV infected persons are living much longer, the role of the cardiovascular specialist is increasingly important in the prevention and management of various cardiac manifestations that may develop in such patients.
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Infection with the human immunodeficiency virus (HIV) causes a number of structural and functional cardiac abnormalities as a result of persistent inflammation, drug toxicities, and opportunistic infections. The clinical scenarios are varied and dependent on levels of immunodeficiency and side effects of antiretroviral therapy (ART). Many patients with HIV, especially those in resource-rich countries, are now living longer as a result of effective combined antiretroviral therapy (cART). Thus, the cardiac presentation in these patients is now similar to that of patients without HIV. However, there remains a substantial number of patients with limited access to newer combination therapy who present with cardiac manifestations related to the acquired immunodeficiency syndrome (AIDS). The approach to the management of these two groups of people living with HIV (PLWH) is divergent and evolving. When considering the evidence presented in this chapter, it is important to differentiate data in the pre-cART era and in resource-poor settings from data obtained in the cART-era and in higher- income settings. The approach to the HIV patient is dependent on their socioeconomic background, and their management and prognosis will be determined by the ART regimen and follow-up that they receive.
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There are more than 37 million PLWH worldwide with an estimated 2 million new infections occurring annually.1 Although the vast majority (70%) of PLWH reside in low- and middle-income countries, over 1 million people with HIV live in the United States, and more than 50% of these are over the age of 50 years (Fig. 77–1).2 Based on data from over 10,000 Dutch patients, by 2030, 73% of HIV-positive patients will be older ...