What is the relationship between cardiomyopathy and Acquired Immune Deficiency Syndrome (AIDS)?

From the Guidelines

Cardiomyopathy is a significant cardiac complication that can occur in patients with HIV/AIDS, and its management includes optimizing antiretroviral therapy (ART) to control HIV infection, along with standard heart failure treatments. The relationship between cardiomyopathy and Acquired Immune Deficiency Syndrome (AIDS) is well-established, with HIV-associated cardiomyopathy typically presenting as dilated cardiomyopathy with reduced left ventricular function 1. This condition can be caused by direct HIV infection of cardiac tissue, opportunistic infections, nutritional deficiencies, autoimmune responses, or as a side effect of antiretroviral medications.

Key Considerations

• The prognosis of HIV cardiomyopathy when untreated remains poor, with a >50% mortality rate in 2 to 3 years, especially among patients in sub-Saharan Africa 1.
• Treatment of HIV with antiretroviral therapy is useful in prevention and treatment of DCM related to HIV 1.
• Patients with HIV cardiomyopathy should be treated with standard guideline-directed medical and device therapies for patients with systolic HF 1.

Management Strategies

• Optimizing antiretroviral therapy (ART) to control HIV infection is crucial in managing HIV-associated cardiomyopathy.
• Standard heart failure treatments, including ACE inhibitors, beta-blockers, and diuretics, should be used as needed for fluid overload.
• Regular cardiac monitoring with echocardiograms every 6-12 months is recommended for HIV patients with cardiac symptoms.
• Early detection through screening echocardiograms in asymptomatic HIV patients with CD4 counts below 200 cells/mm³ may help identify cardiac dysfunction before it becomes clinically apparent 1.

Treatment Recommendations

• Patients with DCM and risk factors for HIV should be screened for HIV as a possible cause of DCM 1.
• Treatment of HIV with antiretroviral therapy is useful in prevention and treatment of DCM related to HIV 1.
• Patients with HIV cardiomyopathy should be treated with standard guideline-directed medical and device therapies for patients with systolic HF 1.

From the Research

Relationship Between Cardiomyopathy and AIDS

The relationship between cardiomyopathy and Acquired Immune Deficiency Syndrome (AIDS) is complex and multifactorial. Key aspects of this relationship include:

• Cardiomyopathy is a significant cardiovascular manifestation of HIV infection, presenting as myocarditis, dilated cardiomyopathy, or isolated left or right ventricular dysfunction 2.
• The introduction of highly active antiretroviral therapy (HAART) has modified the course of HIV disease, reducing the incidence of cardiovascular manifestations, including cardiomyopathy 2, 3.
• Despite the benefits of HAART, cardiomyopathy remains a significant cause of morbidity and mortality among HIV-infected individuals, particularly in low- and middle-income countries 4.

Causes and Clinical Manifestations of HIV-Associated Cardiomyopathy

The causes and clinical manifestations of HIV-associated cardiomyopathy depend on the degree of host immunosuppression. Factors contributing to cardiomyopathy include:

• Direct HIV toxicity, opportunistic infections, and nutritional deficiencies in individuals with unchecked HIV viral replication 4.
• Cardiac autoimmunity, chronic inflammation, and antiretroviral therapy cardiotoxicity in individuals with suppressed viral loads 4.
• Traditional cardiovascular risk factors, such as high rates of smoking, dyslipidemia, and hypertension, which are prevalent in HIV-infected populations 5.

Epidemiology and Clinical Features

The epidemiology and clinical features of cardiovascular disease, including cardiomyopathy, in HIV-infected individuals are changing due to the widespread use of antiretroviral therapy. Key features include:

• A substantially increased risk of myocardial infarction, even when HIV infection is well controlled 5.
• A high prevalence of left ventricular diastolic dysfunction and subclinical cardiac dysfunction in HIV-infected individuals 3, 4.
• The need for further research to identify the prognostic implications of diastolic abnormalities and to develop optimal therapeutic approaches for HIV-associated cardiomyopathy 3, 4.