What are the cardiac diseases associated with Human Immunodeficiency Virus (HIV)?

From the Guidelines

HIV-associated cardiac diseases include cardiomyopathy, pericardial disease, pulmonary hypertension, coronary artery disease, and arrhythmias, which can be effectively managed with antiretroviral therapy and standard heart failure medications, as recommended by the 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA guideline 1. The most common cardiac diseases associated with HIV include:

• Cardiomyopathy, typically presenting as dilated cardiomyopathy with systolic dysfunction
• Pericardial disease, manifesting as pericardial effusion, pericarditis, or cardiac tamponade
• Pulmonary hypertension, occurring at higher rates than in the general population due to chronic inflammation and endothelial dysfunction
• Coronary artery disease, with elevated risk due to chronic inflammation, metabolic complications from antiretroviral therapy, and traditional risk factors
• Arrhythmias and conduction abnormalities, resulting from myocardial inflammation, electrolyte disturbances, or medication effects. According to the 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA guideline, antiretroviral therapy is beneficial in decreasing the risk of cardiovascular events in adults with chronic coronary disease and HIV 1. Additionally, choosing antiretroviral therapy regimens associated with more favorable lipid and cardiovascular risk profiles is reasonable, with consideration of drug-drug interactions 1. The 2016 scientific statement from the American Heart Association also recommends treating HIV with antiretroviral therapy to prevent and treat DCM related to HIV, and using standard guideline-directed medical and device therapies for patients with systolic HF 1.

From the Research

HIV-Associated Cardiac Diseases

HIV infection is associated with various cardiac diseases, including:

• Coronary heart disease, which increases the risk of myocardial infarction even when the HIV infection is well controlled 2
• Nonischemic heart disease, which encompasses a broad spectrum of diseases involving the pericardium, myocardium, coronary arteries, pulmonary vasculature, and valves, as well as the systemic vasculature 3
• Cardiomyopathy and heart failure, which have a changing epidemiology with the advent and widespread use of antiretroviral therapy (ART) 4
• Cardiovascular diseases beyond coronary artery disease, such as heart failure, cerebrovascular disease, sudden cardiac death, pericardial diseases, and pulmonary hypertension 5

Types of HIV-Associated Cardiac Diseases

Some of the specific types of cardiac diseases associated with HIV infection include:

• Myocardial infarction
• Stroke
• Peripheral artery disease
• Heart failure
• Sudden cardiac death
• Atrial fibrillation
• Pulmonary hypertension
• Pericardial diseases

Mechanisms and Risk Factors

The mechanisms underlying HIV-associated cardiac diseases are complex and multifactorial, involving:

• Traditional cardiovascular risk factors, such as tobacco smoking 6
• HIV-related factors, including the use of antiretroviral therapy and chronic inflammation in the setting of effectively treated HIV infection 2
• Chronic immune activation and systemic inflammation, despite highly active ART (HAART) 4