Cardiovascular Complications of HIV in Endemic Countries

Abstract

Effective combination antiretroviral therapy (ART) has enabled human immunodeficiency virus (HIV) infection to evolve from a generally fatal condition to a manageable chronic disease. This transition began two decades ago in high-income countries and has more recently begun in lower income, HIV endemic countries (HIV-ECs). With this transition, there has been a concurrent shift in clinical and public health burden from AIDS-related complications and opportunistic infections to those associated with well-controlled HIV disease, including cardiovascular disease (CVD). In the current treatment era, traditional CVD risk factors and HIV-related factors both contribute to an elevated risk of myocardial infarction, stroke, heart failure, and arrhythmias. In HIV-ECs, the high prevalence of persons living with HIV and growing prevalence of CVD risk factors will contribute to a growing epidemic of HIV-associated CVD. In this review, we discuss the epidemiology and pathophysiology of cardiovascular complications of HIV and the resultant implications for public health efforts in HIV-ECs.

Keywords: Cardiovascular epidemiology; Global health; HIV; Health disparities; Human immunodeficiency virus; Risk factors.

Figure 1.. Conceptual Model: Evolution of HIV-Related Causes of Cardiovascular Morbidity and Mortality.

Dilated cardiomyopathy and myopericarditis were common complications of advanced HIV/AIDS in the pre-ART era. As PLHIV are living longer due to ART, they are increasingly at risk for more common cardiovascular complications, such as myocardial infarction, stroke, and heart failure (including heart failure with preserved ejection fraction). These complications account for an increasing proportion of HIV-related cardiovascular disease.