Prevention of heart failure, tachyarrhythmias and sudden cardiac death in HIV

Abstract

Purpose of reviewTo summarize the state-of-the-art literature on the epidemiology, disease progression, and mediators of heart failure, tachyarrhythmias, and sudden cardiac death in people living with HIV (PLWH) to inform prevention strategies.Recent findingsRecent studies corroborate the role of HIV as a risk enhancer for heart failure and arrhythmias, which persists despite adjustment for cardiovascular risk factors and unhealthy behaviors. Immune activation and inflammation contribute to the risk. Heart failure occurs more frequently at younger ages, and among women and ethnic minorities living with HIV, highlighting disparities. Prospective outcome studies remain sparse in PLWH limiting prevention approaches. However, subclinical cardiac and electrophysiologic remodeling and dysfunction detected by noninvasive testing are powerful disease surrogates that inform our mechanistic understanding of HIV-associated cardiovascular disease and offer opportunities for early diagnosis.SummaryAggressive control of HIV viremia and cardiac risk factors and abstinence from unhealthy behaviors remain treatment pillars to prevent heart failure and arrhythmic complications. The excess risk among PLWH warrants heightened vigilance for heart failure and arrhythmic symptomatology and earlier testing as subclinical abnormalities are common. Future research needs include identifying novel therapeutic targets to prevent heart failure and arrhythmias and testing of interventions in diverse groups of PLWH.

Proteomic Signature of HIV-Associated Subclinical Left Atrial Remodeling and Incident Heart Failure

“…The SMASH study enrolled active participants 40-70 years of age from the Chicago and Baltimore/Washington, DC MACS sites; the Washington, DC WIHS site; and the ALIVE study, which is based in Baltimore. Exclusion criteria included estimated glomerular filtration rate ( eGFR , Chronic Kidney Disease Epidemiology Collaboration 2021) <45 mL/min/1.73 m 2 , weight >350 pounds, known claustrophobia or contrast allergy, and contraindications to CMR. Proteomics was performed on a subset of total SMASH participants with complete CMR and adequate stored plasma volume ( Supplemental Figure S1A ).…”

“…With improved access to early and effective antiretroviral therapy ( ART ), HIV has become a chronic condition marked by higher risk and earlier onset of aging-related diseases, including cardiovascular disease ( CVD ). 1 People living with HIV ( PLWH ), even when virologically suppressed due to ART, are at higher risk of myocardial diseases, 2 such as incident heart failure ( HF ) 3–5 and atrial fibrillation ( AF ). 6 Advanced HIV disease has been classically associated with left ventricular ( LV ) systolic dysfunction and dilated cardiomyopathy, but with effective ART, this phenotype has transitioned to one characterized by subclinical abnormalities in cardiac structure and function that may presage clinical HF, particularly HF with preserved ejection fraction ( EF ).…”

Clinical Application of Cardiac Magnetic Resonance in ART-Treated AIDS Males with Short Disease Duration

“…Previous studies reported that the incidence of cardiac complications in AIDS patients is approximately 25–75%, and the incidence increases as AIDS patients age [ 3 , 4 , 5 , 6 ]. In addition, a review concluded that AIDS patients affected by cardiac complications always had a poor prognosis [ 7 ]. AIDS-related symptomatic heart failure will become one of the leading causes of HIV/AIDS deaths worldwide in the future [ 8 ].…”

Association Between Left Ventricular Scar and Ventricular Ectopy in People Living With and Without HIV

“… 2 PLWH have greater risk for sudden arrhythmic cardiac death and heart failure, in part due to higher prevalence of traditional cardiovascular risk factors and unhealthy behaviors, metabolic dysregulation from cART, immune dysregulation, and/or chronic immune activation. 3 However, subclinical markers identifying specific subgroups of PLWH at elevated cardiovascular risk remain understudied but could inform prevention and therapeutic strategies. Abnormal myocardial substrate, including greater myocardial scar burden, is a marker for increased risk for arrhythmias and heart failure among the general population.…”