A Systematic Review of How To Reduce Morbidity in HIV Patients With Cardiovascular Diseases

Abstract

The human immunodeficiency virus (HIV) is known to cause cardiovascular diseases in patients infected with HIV. The pathology ranges from atherosclerosis to cardiomyopathy. There are several factors that could possibly cause cardiovascular diseases in the HIV population, including malnutrition and vitamin deficiency (for example, thiamine, B12, and zinc deficiencies); a lifestyle including increased prevalence of alcoholism and illicit drug usage; viral infection; and medication combinations that could cause sudden cardiac deaths. Cardiovascular diseases contribute to major morbidity in these populations and could have a reflection on the global financial burden, thus emphasizing the importance of prevention strategies. In this article, we focused on several factors that contribute to coronary artery disease and other cardiovascular diseases. We found that HIV has direct and indirect effects on the development of coronary artery diseases; furthermore, antiretroviral therapy adds to the deleterious effects of HIV and increases the risk of cardiovascular diseases. We further assessed the causal relationships and associations to understand the research gaps.In conclusion, this paper acknowledges and summarizes the current management strategies and the need to develop future strategies focusing on the prevention of cardiovascular diseases and tailoring the regimens according to the patient's clinical and socio-economic background.

Evaluating the use of antiviral drugs in HIV patients with cardiovascular diseases and how to reduce the incidence of cardiac events in these patients

“…NRTI, for example, causes mitochondrial toxicity, whereas PI stimulates hepatic cytochrome p450. PIs are also linked to dyslipidemia and fibrinogenemia, while NNRTIs elevate total cholesterol and LDL-C [15,30]. Efavirenz induces hyperlipidemia, which is indicative of the use of HAART and its association with a number of cardiovascular system-damaging effects that result in CVDs [31].…”

“…The prevalence of CVD is elevated among PLWH undergoing the HAART regimen, according to the findings of Muller et al [33], when metabolic alterations are considered in these populations. While the precise origins of these presentations remain unknown, it is hypothesized that they serve to implement individualized treatment and early prevention strategies based on the backgrounds of specific patients [30]. Tiarukkitsagul et al [34] discovered that among PLWH, the 10-year risk of ASCVD was significantly higher for those on second-line ART (a ritonavir-boosted PI) than for those on first-line ART (an NNRTI-based regimen).…”

“…Although they have the potential to prevent CVD in PLWH, clinicians are not prescribing enough of them. The factors contributing to this and their utilization are diverse, spanning from patient-related concerns such as nonadherence and ignorance of the advantages of statins to clinician-level factors such as inadequate understanding of prescribing guidelines [30,43].…”