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Hudson JA, Ferrand RA, Gitau SN, Mureithi MW, Maffia P, Alam SR, Shah ASV. HIV-Associated Cardiovascular Disease Pathogenesis: An Emerging Understanding Through Imaging and Immunology. Circ Res 2024; 134:1546-1565. [PMID: 38781300 DOI: 10.1161/circresaha.124.323890] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
Cardiac abnormalities were identified early in the epidemic of AIDS, predating the isolation and characterization of the etiologic agent, HIV. Several decades later, the causation and pathogenesis of cardiovascular disease (CVD) linked to HIV infection continue to be the focus of intense speculation. Before the widespread use of antiretroviral therapy, HIV-associated CVD was primarily characterized by HIV-associated cardiomyopathy linked to profound immunodeficiency. With increasing antiretroviral therapy use, viral load suppression, and establishment of immune competency, the effects of HIV on the cardiovascular system are more subtle. Yet, people living with HIV still face an increased incidence of cardiovascular pathology. Advances in cardiac imaging modalities and immunology have deepened our understanding of the pathogenesis of HIV-associated CVD. This review provides an overview of the pathogenesis of HIV-associated CVD integrating data from imaging and immunologic studies with particular relevance to the HIV population originating from high-endemic regions, such as sub-Saharan Africa. The review highlights key evidence gaps in the field and suggests future directions for research to better understand the complex HIV-CVD interactions.
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Affiliation(s)
- Jonathan A Hudson
- Kings College London BHF Centre, School of Cardiovascular and Metabolic Medicine & Sciences, United Kingdom (J.A.H.)
| | - Rashida A Ferrand
- Department of Clinical Research (R.A.F.), London School of Hygiene and Tropical Medicine, United Kingdom
- Biomedical Research and Training Institute, Harare, Zimbabwe (R.A.F.)
| | - Samuel N Gitau
- Department of Radiology, Aga Khan University Nairobi, Kenya (S.N.G.)
| | - Marianne Wanjiru Mureithi
- Department of Medical Microbiology and Immunology, Faculty of Health Sciences (M.W.M.), University of Nairobi, Kenya
| | - Pasquale Maffia
- School of Infection and Immunity, College of Medical, Veterinary and Life Sciences, University of Glasgow, United Kingdom (P.M.)
- Department of Pharmacy, School of Medicine and Surgery, University of Naples Federico II, Italy (P.M.)
- Africa-Europe Cluster of Research Excellence in Non-Communicable Diseases and Multimorbidity, African Research Universities Alliance and The Guild of European Research-Intensive Universities, Glasgow, United Kingdom (P.M.)
| | - Shirjel R Alam
- Department of Cardiology, North Bristol NHS Trust, United Kingdom (S.R.A.)
| | - Anoop S V Shah
- Department of Non-Communicable Disease Epidemiology (A.S.V.S.), London School of Hygiene and Tropical Medicine, United Kingdom
- Department of Cardiology, Imperial College NHS Trust, London, United Kingdom (A.S.V.S.)
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2
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Abd-Elmoniem KZ, Ishaq H, Purdy J, Matta J, Hamimi A, Hannoush H, Hadigan C, Gharib AM. Association of Coronary Wall Thickening and Diminished Diastolic Function in Asymptomatic, Low Cardiovascular Disease-Risk Persons Living with HIV. Radiol Cardiothorac Imaging 2024; 6:e230102. [PMID: 38573125 PMCID: PMC11056756 DOI: 10.1148/ryct.230102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 12/19/2023] [Accepted: 02/14/2024] [Indexed: 04/05/2024]
Abstract
Purpose To assess early subclinical coronary artery disease (CAD) burden and its relation to myocardial function in asymptomatic persons living with HIV (PLWH) who are at low risk for cardiovascular disease (CVD). Materials and Methods In this prospective, HIPAA-compliant study (ClinicalTrials.gov NCT01656564 and NCT01399385) conducted from April 2010 to May 2013, 74 adult PLWH without known CVD and 25 matched healthy controls underwent coronary MRI to measure coronary vessel wall thickness (VWT) and echocardiography to assess left ventricular function. Univariable and multivariable linear regression analyses were used to evaluate statistical associations. Results For PLWH, the mean age was 49 years ± 11 (SD), and the median Framingham risk score was 3.2 (IQR, 0.5-6.6); for matched healthy controls, the mean age was 46 years ± 8 and Framingham risk score was 2.3 (IQR, 0.6-6.1). PLWH demonstrated significantly greater coronary artery VWT than did controls (1.47 mm ± 0.22 vs 1.34 mm ± 0.18; P = .006) and a higher left ventricular mass index (LVMI) (77 ± 16 vs 70 ± 13; P = .04). Compared with controls, PLWH showed altered association between coronary artery VWT and both E/A (ratio of left ventricular-filling peak blood flow velocity in early diastole [E wave] to that in late diastole [A wave]) (P = .03) and LVMI (P = .04). In the PLWH subgroup analysis, coronary artery VWT increase was associated with lower E/A (P < .001) and higher LVMI (P = .03), indicating restricted diastolic function. In addition, didanosine exposure was associated with increased coronary artery VWT and decreased E/A ratio. Conclusion Asymptomatic low-CVD-risk PLWH demonstrated increased coronary artery VWT in association with impaired diastolic function, which may be amenable to follow-up studies of coronary pathogenesis to identify potential effects on the myocardium and risk modification strategies. Keywords: Coronary Vessel Wall Thickness, Diastolic Function, HIV, MRI, Echocardiography, Atherosclerosis Clinical trial registration nos. NCT01656564 and NCT01399385 Supplemental material is available for this article. © RSNA, 2024.
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Affiliation(s)
- Khaled Z. Abd-Elmoniem
- From the Biomedical and Metabolic Imaging Branch, National Institute
of Diabetes and Digestive and Kidney Diseases (K.Z.A.E., H.I., J.M., A.H.,
A.M.G.), Critical Care Medicine Department, National Institutes of Health
Clinical Center (J.P.), National Human Genome Research Institute (H.H.), and
National Institute of Allergy and Infectious Diseases (C.H.), National
Institutes of Health, 10 Center Dr, Bethesda, MD 20892; and Department of
Radiology, University of Chicago, Chicago, Ill (A.H.)
| | - Hadjira Ishaq
- From the Biomedical and Metabolic Imaging Branch, National Institute
of Diabetes and Digestive and Kidney Diseases (K.Z.A.E., H.I., J.M., A.H.,
A.M.G.), Critical Care Medicine Department, National Institutes of Health
Clinical Center (J.P.), National Human Genome Research Institute (H.H.), and
National Institute of Allergy and Infectious Diseases (C.H.), National
Institutes of Health, 10 Center Dr, Bethesda, MD 20892; and Department of
Radiology, University of Chicago, Chicago, Ill (A.H.)
| | - Julia Purdy
- From the Biomedical and Metabolic Imaging Branch, National Institute
of Diabetes and Digestive and Kidney Diseases (K.Z.A.E., H.I., J.M., A.H.,
A.M.G.), Critical Care Medicine Department, National Institutes of Health
Clinical Center (J.P.), National Human Genome Research Institute (H.H.), and
National Institute of Allergy and Infectious Diseases (C.H.), National
Institutes of Health, 10 Center Dr, Bethesda, MD 20892; and Department of
Radiology, University of Chicago, Chicago, Ill (A.H.)
| | - Jatin Matta
- From the Biomedical and Metabolic Imaging Branch, National Institute
of Diabetes and Digestive and Kidney Diseases (K.Z.A.E., H.I., J.M., A.H.,
A.M.G.), Critical Care Medicine Department, National Institutes of Health
Clinical Center (J.P.), National Human Genome Research Institute (H.H.), and
National Institute of Allergy and Infectious Diseases (C.H.), National
Institutes of Health, 10 Center Dr, Bethesda, MD 20892; and Department of
Radiology, University of Chicago, Chicago, Ill (A.H.)
| | - Ahmed Hamimi
- From the Biomedical and Metabolic Imaging Branch, National Institute
of Diabetes and Digestive and Kidney Diseases (K.Z.A.E., H.I., J.M., A.H.,
A.M.G.), Critical Care Medicine Department, National Institutes of Health
Clinical Center (J.P.), National Human Genome Research Institute (H.H.), and
National Institute of Allergy and Infectious Diseases (C.H.), National
Institutes of Health, 10 Center Dr, Bethesda, MD 20892; and Department of
Radiology, University of Chicago, Chicago, Ill (A.H.)
| | - Hwaida Hannoush
- From the Biomedical and Metabolic Imaging Branch, National Institute
of Diabetes and Digestive and Kidney Diseases (K.Z.A.E., H.I., J.M., A.H.,
A.M.G.), Critical Care Medicine Department, National Institutes of Health
Clinical Center (J.P.), National Human Genome Research Institute (H.H.), and
National Institute of Allergy and Infectious Diseases (C.H.), National
Institutes of Health, 10 Center Dr, Bethesda, MD 20892; and Department of
Radiology, University of Chicago, Chicago, Ill (A.H.)
| | - Colleen Hadigan
- From the Biomedical and Metabolic Imaging Branch, National Institute
of Diabetes and Digestive and Kidney Diseases (K.Z.A.E., H.I., J.M., A.H.,
A.M.G.), Critical Care Medicine Department, National Institutes of Health
Clinical Center (J.P.), National Human Genome Research Institute (H.H.), and
National Institute of Allergy and Infectious Diseases (C.H.), National
Institutes of Health, 10 Center Dr, Bethesda, MD 20892; and Department of
Radiology, University of Chicago, Chicago, Ill (A.H.)
| | - Ahmed M. Gharib
- From the Biomedical and Metabolic Imaging Branch, National Institute
of Diabetes and Digestive and Kidney Diseases (K.Z.A.E., H.I., J.M., A.H.,
A.M.G.), Critical Care Medicine Department, National Institutes of Health
Clinical Center (J.P.), National Human Genome Research Institute (H.H.), and
National Institute of Allergy and Infectious Diseases (C.H.), National
Institutes of Health, 10 Center Dr, Bethesda, MD 20892; and Department of
Radiology, University of Chicago, Chicago, Ill (A.H.)
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Kamvuma K, Hamooya BM, Munsaka S, Masenga SK, Kirabo A. Mechanisms and Cardiorenal Complications of Chronic Anemia in People with HIV. Viruses 2024; 16:542. [PMID: 38675885 PMCID: PMC11053456 DOI: 10.3390/v16040542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 03/26/2024] [Accepted: 03/29/2024] [Indexed: 04/28/2024] Open
Abstract
Chronic anemia is more prevalent in people living with HIV (PLWH) compared to the general population. The mechanisms that drive chronic anemia in HIV are multifaceted and include functional impairment of hematopoietic stem cells, dysregulation of erythropoietin production, and persistent immune activation. Chronic inflammation from HIV infection adversely affects erythropoiesis, erythrocyte lifespan, and erythropoietin response, leading to a heightened risk of co-infections such as tuberculosis, persistent severe anemia, and increased mortality. Additionally, chronic anemia exacerbates the progression of HIV-associated nephrotoxicity and contributes to cardiovascular risk through immune activation and inflammation. This review highlights the cardinal role of chronic inflammation as a link connecting persistent anemia and cardiovascular complications in PLWH, emphasizing the need for a universal understanding of these interconnected pathways for targeted interventions.
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Affiliation(s)
- Kingsley Kamvuma
- HAND Research Group, School of Medicine and Health Sciences, Mulungushi University, Livingstone Campus, Livingstone 10101, Zambia; (K.K.); (B.M.H.)
| | - Benson M. Hamooya
- HAND Research Group, School of Medicine and Health Sciences, Mulungushi University, Livingstone Campus, Livingstone 10101, Zambia; (K.K.); (B.M.H.)
| | - Sody Munsaka
- Department of Biomedical Sciences, School of Health Sciences, University of Zambia, Lusaka P.O Box 50110, Zambia;
| | - Sepiso K. Masenga
- HAND Research Group, School of Medicine and Health Sciences, Mulungushi University, Livingstone Campus, Livingstone 10101, Zambia; (K.K.); (B.M.H.)
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Annet Kirabo
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN 37232, USA
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, USA
- Vanderbilt Center for Immunobiology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
- Vanderbilt Institute for Infection, Immunology and Inflammation, Vanderbilt University Medical Center, Nashville, TN 37232, USA
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Weisleder H, Jacobson E, Frishman WH, Dhand A. Cardiac Manifestations of Viral Infections, Including COVID-19: A Review. Cardiol Rev 2024; 32:124-130. [PMID: 36730913 DOI: 10.1097/crd.0000000000000481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Viral infections have been linked to a variety of cardiac pathology, which may include acute myocarditis, dilated cardiomyopathy, heart failure, cardiogenic shock, pericarditis, acute coronary syndromes, and arrhythmias. We performed a systematic review of literature focusing on the cardiovascular effects of various viral infections, as well as providing an update on the current understanding of the pathophysiology of Coronavirus disease-2019 (COVID-19). Cardiac manifestations of viral illnesses are usually self-limiting, have variable clinical presentations, and require sufficient clinical suspicion for diagnosis and optimal management.
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Affiliation(s)
| | | | | | - Abhay Dhand
- From the New York Medical College, Valhalla, NY
- Department of Medicine and Surgery, Westchester Medical Center, Valhalla, NY
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Togashi D, Harada T, Nakajima I, Kasagawa A, Nakayama Y, Sasaki K, Akashi YJ. Successful Epicardial Radiofrequency Ablation of Ventricular Tachycardia That Shared a Pathway with Bi-Directional Conduction in a Patient with Human Immunodeficiency Virus-Associated Cardiomyopathy. Int Heart J 2023; 64:1157-1161. [PMID: 37967987 DOI: 10.1536/ihj.23-205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
A 59-year-old man who had been diagnosed with human immunodeficiency virus-associated cardiomyopathy was referred for catheter ablation of ventricular tachycardia (VT). An electrocardiogram (ECG) waveform revealed that the clinical VT originated from the epicardium. A deceleration zone (DZ) was identified on an isochronal late activation map. Moreover, 2 forms of monomorphic VT were induced by different cycle length burst pacings from near the DZ. The morphologies of the 2 VTs with an identical cycle length were very likely to use a shared common pathway with bi-directional conduction around the slow conduction area in the left ventricle posterolateral small epicardial surface area. After ablation of the DZ, the VT was uninducible.
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Affiliation(s)
- Daisuke Togashi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine
| | - Tomoo Harada
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine
| | - Ikutaro Nakajima
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine
| | - Akira Kasagawa
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine
| | - Yui Nakayama
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine
| | - Kenichi Sasaki
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine
| | - Yoshihiro J Akashi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine
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6
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Serrano-Villar S, Moltó-Marhuenda J, Montero-Alonso M, Diaz-Torné C, López-Cavanillas M, Pérez de Isla L. Knowledge, attitudes and practices in HIV-related chronic inflammation and cardiovascular risk in Spain. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2023:S2529-993X(23)00261-7. [PMID: 37945466 DOI: 10.1016/j.eimce.2023.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 07/27/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND People with HIV (PWH) in suppressive antiretroviral treatment suffer from chronic inflammation-related comorbidities, mainly cardiovascular diseases. However, given the lack of specific evidence about inflammation in PWH, clinical guidelines do not provide recommendations for the management of this issue. To date, physician awareness of inflammation in PWH remains unclear. We analyzed the knowledge, attitudes, and practices (KAP) related to inflammation, particularly in the clinical management of PWH, of infectious disease specialists (IDS)/internists compared to other specialists treating inflammation directly (rheumatologists) or its cardiovascular consequences (cardiologists). METHODS A committee of IDS/internists treating PWH, cardiologists, and rheumatologists designed the KAP questionnaire. The survey was completed by 405 participants (135 physicians per specialty) stratified by Spanish geography, hospital size, and number of PWH under care (IDS/internists only). RESULTS IDS/internists treating PWH scored higher than cardiologists and rheumatologists on knowledge of inflammation (5.5±1.4 out of 8 points vs. 5.2±1.3 and 4.6±1.4 points, respectively; p<0.05). Nevertheless, rheumatologists showed the most proactive attitude toward inflammation (i.e., biomarkers monitoring, anti-inflammatory drug prescription and cardiologist referral), followed by cardiologists and IDS/internists (13±3 of a total of 16 points vs. 11±3 and 10±3.3 points, respectively; p<0.05), irrespective of hospital size and years of experience. Most IDS/internists (59%) include inflammation in their therapeutic recommendations. However, in IDS/internists treating PWH, we observed a negative correlation between years of experience and concern about the clinical consequences of inflammation. CONCLUSION Our findings show that, compared to other specialists, infectious disease specialists/internists have high knowledge about inflammation in HIV infection, but, in the absence of scientific evidence to base their decisions on inflammatory markers, the therapeutic implications are scarce. The results support the need for more evidence on the monitoring and treatment of inflammation in PWH.
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Affiliation(s)
- Sergio Serrano-Villar
- Department of Infectious Diseases, Ramon y Cajal Hospital and IRYCIS, Madrid, Spain; Centro de Investigación en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain.
| | - José Moltó-Marhuenda
- Centro de Investigación en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain; Infectious Diseases Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Fight AIDS and Infectious Diseases Foundation, Badalona, Barcelona, Spain
| | | | - Cesar Diaz-Torné
- Rheumatology Department, Sant Pau i Santa Creu Hospital, Barcelona, Spain
| | | | - Leopoldo Pérez de Isla
- Cardiology Department, San Carlos Clinic Hospital, Universidad Complutense, Madrid, Spain
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7
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Lasica R, Djukanovic L, Savic L, Krljanac G, Zdravkovic M, Ristic M, Lasica A, Asanin M, Ristic A. Update on Myocarditis: From Etiology and Clinical Picture to Modern Diagnostics and Methods of Treatment. Diagnostics (Basel) 2023; 13:3073. [PMID: 37835816 PMCID: PMC10572782 DOI: 10.3390/diagnostics13193073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 09/22/2023] [Accepted: 09/25/2023] [Indexed: 10/15/2023] Open
Abstract
Although the frequency of myocarditis in the general population is very difficult to accurately determine due to the large number of asymptomatic cases, the incidence of this disease is increasing significantly due to better defined criteria for diagnosis and the development of modern diagnostic methods. The multitude of different etiological factors, the diversity of the clinical picture, and the variability of the diagnostic findings make this disease often demanding both for the selection of the diagnostic modality and for the proper therapeutic approach. The previously known most common viral etiology of this disease is today overshadowed by new findings based on immune-mediated processes, associated with diseases that in their natural course can lead to myocardial involvement, as well as the iatrogenic cause of myocarditis, which is due to use of immune checkpoint inhibitors in the treatment of cancer patients. Suspecting that a patient with polymorphic and non-specific clinical signs and symptoms, such as changes in ECG and echocardiography readings, has myocarditis is the starting point in the diagnostic algorithm. Cardio magnetic resonance imaging is non-invasive and is the gold standard for diagnosis and clinical follow-up of these patients. Endomyocardial biopsy as an invasive method is the diagnostic choice in life-threatening cases with suspicion of fulminant myocarditis where the diagnosis has not yet established or there is no adequate response to the applied therapeutic regimen. The treatment of myocarditis is increasingly demanding and includes conservative methods of treating heart failure, immunomodulatory and immunospressive therapy, methods of mechanical circulatory support, and heart transplantation. The goal of developing new diagnostic and therapeutic methods is to reduce mortality from this complex disease, which is still high.
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Affiliation(s)
- Ratko Lasica
- Department of Cardiology, Emergency Center, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (L.D.); (L.S.); (G.K.); (M.A.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
| | - Lazar Djukanovic
- Department of Cardiology, Emergency Center, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (L.D.); (L.S.); (G.K.); (M.A.)
| | - Lidija Savic
- Department of Cardiology, Emergency Center, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (L.D.); (L.S.); (G.K.); (M.A.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
| | - Gordana Krljanac
- Department of Cardiology, Emergency Center, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (L.D.); (L.S.); (G.K.); (M.A.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
| | - Marija Zdravkovic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
- Department of Cardiology, University Medical Center Bezanijska Kosa, 11000 Belgrade, Serbia
| | - Marko Ristic
- Department of Cardiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia;
| | | | - Milika Asanin
- Department of Cardiology, Emergency Center, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (L.D.); (L.S.); (G.K.); (M.A.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
| | - Arsen Ristic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
- Department of Cardiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia;
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8
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Henning RJ, Greene JN. The epidemiology, mechanisms, diagnosis and treatment of cardiovascular disease in adult patients with HIV. AMERICAN JOURNAL OF CARDIOVASCULAR DISEASE 2023; 13:101-121. [PMID: 37213313 PMCID: PMC10193251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 03/22/2023] [Indexed: 05/23/2023]
Abstract
More than 1.2 million people in the United States have Human Immunodeficiency Virus (HIV) infections but 13% of these people are unaware of their HIV infection. Current combination antiretroviral therapy (ART) does not cure HIV infection but rather suppresses the infection with the virus persisting indefinitely in latent reservoirs in the body. As a consequence of ART, HIV infection has changed from a fatal disease in the past to a chronic disease today. Currently in the United States, more than 45% of HIV+ individuals are greater than 50 years of age and 25% will be greater than 65 years of age by 2030. Atherosclerotic cardiovascular disease (CVD), including myocardial infarction, stroke, and cardiomyopathy, is now the major cause of death in HIV+ individuals. Novel risk factors, including chronic immune activation and inflammation in the body, antiretroviral therapy, and traditional CVD risk factors, such as tobacco and illicit drug use, hyperlipidemia, the metabolic syndrome, diabetes mellitus, hypertension, and chronic renal disease, contribute to cardiovascular atherosclerosis. This article discusses the complex interactions involving HIV infection, the novel and traditional risk factors for CVD, and the antiretroviral HIV therapies which can contribute to CVD in HIV-infected people. In addition, the treatment of HIV+ patients with acute myocardial infarction, stroke, and cardiomyopathy/heart failure are discussed. Current recommended ART and their major side effects are summarized in table format. All medical personnel must be aware of the increasing incidence of CVD on the morbidity and mortality in HIV infected patients and must be watchful for the presence of CVD in their patients with HIV.
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Affiliation(s)
- Robert J Henning
- University of South Florida and The Moffitt Cancer Center Tampa, Florida, USA
| | - John N Greene
- University of South Florida and The Moffitt Cancer Center Tampa, Florida, USA
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9
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Laraghy M, McCullough J, Gerrard J, Stroebel A, Winearls J. Venoarterial extracorporeal membrane oxygenation for cardiac support in human immunodeficiency virus-positive patients: a case report and review of a multicentre registry. J Cardiothorac Surg 2023; 18:109. [PMID: 37029414 PMCID: PMC10080512 DOI: 10.1186/s13019-023-02191-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 03/26/2023] [Indexed: 04/09/2023] Open
Abstract
BACKGROUND Human immunodeficiency virus (HIV) is associated with increased risk of heart failure via multiple mechanisms both in patients with and without access to highly active antiretroviral therapy (HAART). Limited information is available on outcomes among this population supported on Venoarterial Extracorporeal Membrane Oxygenation (VA ECMO), a form of temporary mechanical circulatory support. METHODS We aimed to assess outcomes and complications among patients with HIV supported on VA ECMO reported to a multicentre registry and present a case report of a 32 year old male requiring VA ECMO for cardiogenic shock as a consequence of his untreated HIV and acquired immune deficiency syndrome (AIDS). A retrospective analysis of the Extracorporeal Life Support Organization (ELSO) registry data from 1989 to 2019 was performed in HIV patients supported on VA ECMO. RESULTS 36 HIV positive patients were reported to the ELSO Database who received VA ECMO during the study period with known outcomes. 15 patients (41%) survived to discharge. No significant differences existed between survivors and non-survivors in demographic variables, duration of VA ECMO support or cardiac parameters. Inotrope and/or vasopressor requirement prior to or during VA ECMO support was associated with increased mortality. Survivors were more likely to develop circuit thrombosis. The patient presented was supported on VA ECMO for 14 days and was discharged from hospital day 85. CONCLUSIONS A limited number of patients with HIV have been supported with VA ECMO and more data is required to ascertain the indications for ECMO in this population. HIV should not be considered an absolute contraindication to VA ECMO as they may have comparable outcomes to other patient groups requiring VA ECMO support.
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Affiliation(s)
- Matthew Laraghy
- Intensive Care, Gold Coast University Hospital, Gold Coast, QLD, Australia.
| | - James McCullough
- Intensive Care, Gold Coast University Hospital, Gold Coast, QLD, Australia
| | - John Gerrard
- Infectious Diseases and Immunology, Gold Coast University Hospital, Gold Coast, QLD, Australia
| | - Andrie Stroebel
- Cardiothoracic Surgery, Gold Coast University Hospital, Gold Coast, QLD, Australia
| | - James Winearls
- Intensive Care, Gold Coast University Hospital, Gold Coast, QLD, Australia
- School of Medicine, University of Queensland, St. Lucia, QLD, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- St Andrew's War Memorial Hospital, Brisbane, QLD, Australia
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10
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Kumar P, Arendt C, Martin S, Al Soufi S, DeLeuw P, Nagel E, Puntmann VO. Multimodality Imaging in HIV-Associated Cardiovascular Complications: A Comprehensive Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2201. [PMID: 36767567 PMCID: PMC9915416 DOI: 10.3390/ijerph20032201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/17/2023] [Accepted: 01/20/2023] [Indexed: 06/18/2023]
Abstract
Human immunodeficiency virus (HIV) infection is a leading cause of mortality and morbidity worldwide. The introduction of antiretroviral therapy (ART) has significantly reduced the risk of developing acquired immune deficiency syndrome and increased life expectancy, approaching that of the general population. However, people living with HIV have a substantially increased risk of cardiovascular diseases despite long-term viral suppression using ART. HIV-associated cardiovascular complications encompass a broad spectrum of diseases that involve the myocardium, pericardium, coronary arteries, valves, and systemic and pulmonary vasculature. Traditional risk stratification tools do not accurately predict cardiovascular risk in this population. Multimodality imaging plays an essential role in the evaluation of various HIV-related cardiovascular complications. Here, we emphasize the role of multimodality imaging in establishing the diagnosis and aetiopathogenesis of various cardiovascular manifestations related to chronic HIV disease. This review also provides a critical appraisal of contemporary data and illustrative cases.
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Affiliation(s)
- Parveen Kumar
- Institute of Experimental and Translational Cardiac Imaging, DZHK, Centre for Cardiovascular Imaging, University Hospital Frankfurt, 60590 Frankfurt am Main, Germany
| | - Christophe Arendt
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60590 Frankfurt am Main, Germany
| | - Simon Martin
- Institute of Experimental and Translational Cardiac Imaging, DZHK, Centre for Cardiovascular Imaging, University Hospital Frankfurt, 60590 Frankfurt am Main, Germany
| | - Safaa Al Soufi
- Institute of Experimental and Translational Cardiac Imaging, DZHK, Centre for Cardiovascular Imaging, University Hospital Frankfurt, 60590 Frankfurt am Main, Germany
| | | | - Eike Nagel
- Institute of Experimental and Translational Cardiac Imaging, DZHK, Centre for Cardiovascular Imaging, University Hospital Frankfurt, 60590 Frankfurt am Main, Germany
| | - Valentina O. Puntmann
- Institute of Experimental and Translational Cardiac Imaging, DZHK, Centre for Cardiovascular Imaging, University Hospital Frankfurt, 60590 Frankfurt am Main, Germany
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11
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Subclinical Left Ventricular Systolic Dysfunction in HIV Patients: Prevalence and Associations with Carotid Atherosclerosis and Increased Adiposity. J Clin Med 2022; 11:jcm11071804. [PMID: 35407412 PMCID: PMC8999414 DOI: 10.3390/jcm11071804] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 03/22/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Human immunodeficiency virus (HIV) is mainly detected in young, otherwise healthy, individuals. Cardiomyopathy and peripheral artery disease affecting these patients appears to be multifactorial. Prompt and potentially more effective implementation of therapeutic measures could be enabled by pre-symptomatic diagnosis of myocardial dysfunction and peripheral artery damage. However, limited data is available to date on this specific topic. Μethods: We investigated the association between global longitudinal strain (GLS), an established index of subclinical left ventricular systolic dysfunction (LVSD) assessed by two-dimensional speckle-tracking echocardiography, and: (a) patient history; (b) demographic and clinical baseline characteristics; (c) carotid intima-media thickness (IMT) and the presence of carotid atherosclerotic plaque(s), measured by ultrasonography; (d) temperature difference (ΔT) along each carotid artery, measured by microwave radiometry; and (e) basic blood panel measurements, including high-sensitivity troponin-T (hsTnT) and NT-proBNP in people living with HIV (PLWH) and no history of cardiovascular disease. RESULTS We prospectively enrolled 103 consecutive PLWH (95% male, age 47 ± 11 years, anti-retroviral therapy 100%) and 52 age- and sex-matched controls. PLWH had a significantly higher relative wall thickness (0.38 ± 0.08 vs. 0.36 ± 0.04, p = 0.048), and higher rate of LVSD (34% vs. 15.4%, p = 0.015), and carotid artery atherosclerosis (28% vs. 6%, p = 0.001) compared with controls. Among PLWH, LVSD was independently associated with the presence of carotid atherosclerosis (adj. OR:3.09; 95%CI:1.10-8.67, p = 0.032) and BMI (1.15; 1.03-1.29, p = 0.017), while a trend for association between LVSD and left ventricular hypertrophy was also noted (3.12; 0.73-13.33, p = 0.124). No differences were seen in microwave radiometry parameters, NT-proBNP, hs-TnT and c-reactive protein between PLWH with and without LVSD. CONCLUSIONS Subclinical LVSD and carotid atherosclerosis were significantly more frequent in PLWH compared to a group of healthy individuals, implying a possible link between HIV infection and these two pathological processes. Carotid atherosclerosis and increased adiposity were independently associated with impaired GLS in HIV-infected individuals.
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12
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Gambahaya ET, Rana R, Bagchi S, Sharma G, Sarkar S, Goerlich E, Cupido B, Mukherjee M, Hays AG. The Role of Multimodality Imaging in HIV-Associated Cardiomyopathy. Front Cardiovasc Med 2022; 8:811593. [PMID: 35155615 PMCID: PMC8826063 DOI: 10.3389/fcvm.2021.811593] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 12/30/2021] [Indexed: 11/13/2022] Open
Abstract
Despite marked advances in therapeutics, HIV infection remains a leading cause of morbidity and mortality worldwide. HIV infection is associated with cardiovascular complications including myocardial dysfunction. The description of HIV-associated cardiomyopathy (HIVAC) has evolved over time from a predominantly dilated cardiomyopathy with systolic dysfunction to one of subclinical diastolic dysfunction. Multimodality cardiovascular imaging plays an integral role in our understanding of the etiology and pathogenesis of HIVAC. Such imaging is also essential in the evaluation of individuals with chronic HIV disease who present with cardiac symptoms, especially of heart failure. In the present review, we will highlight current evidence for the role of multimodality imaging in establishing the diagnosis, etiology and pathophysiology of HIVAC as well as guiding treatment and assessing prognosis.
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Affiliation(s)
- Ellise T. Gambahaya
- Division of Cardiology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Observatory, Cape Town, South Africa
| | - Rimsha Rana
- Department of Medicine, Georgetown University School of Medicine, Baltimore, MD, United States
| | - Shashwatee Bagchi
- Division of Infectious Disease and Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Garima Sharma
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Sudipa Sarkar
- Division of Endocrinology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Erin Goerlich
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Blanche Cupido
- Division of Cardiology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Observatory, Cape Town, South Africa
| | - Monica Mukherjee
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Allison G. Hays
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- *Correspondence: Allison G. Hays
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13
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Srinivasa S, Thomas TS, Feldpausch MN, Adler GK, Grinspoon SK. Coronary Vasculature and Myocardial Structure in HIV: Physiologic Insights From the Renin-Angiotensin-Aldosterone System. J Clin Endocrinol Metab 2021; 106:3398-3412. [PMID: 33624807 PMCID: PMC8864747 DOI: 10.1210/clinem/dgab112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Indexed: 11/19/2022]
Abstract
The landscape of HIV medicine dramatically changed with the advent of contemporary antiretroviral therapies, which has allowed persons with HIV (PWH) to achieve good virologic control, essentially eliminating HIV-related complications and increasing life expectancy. As PWH are living longer, noncommunicable diseases, such as cardiovascular disease (CVD), have become a leading cause of morbidity and mortality in PWH with rates that are 50% to 100% higher than in well-matched persons without HIV. In this review, we focus on disease of the coronary microvasculature and myocardium in HIV. We highlight a key hormonal system important to cardiovascular endocrinology, the renin-angiotensin-aldosterone system (RAAS), as a potential mediator of inflammatory driven-vascular and myocardial injury and consider RAAS blockade as a physiologically targeted strategy to reduce CVD in HIV.
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Affiliation(s)
- Suman Srinivasa
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Teressa S Thomas
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Meghan N Feldpausch
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Gail K Adler
- Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Steven K Grinspoon
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Correspondence: Steven K. Grinspoon, MD, Metabolism Unit, Massachusetts General Hospital, 55 Fruit Street, 5LON207, Boston, MA 02114, USA. E-mail:
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14
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Viruses in the Heart: Direct and Indirect Routes to Myocarditis and Heart Failure. Viruses 2021; 13:v13101924. [PMID: 34696354 PMCID: PMC8537553 DOI: 10.3390/v13101924] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/09/2021] [Accepted: 09/21/2021] [Indexed: 01/01/2023] Open
Abstract
Viruses are an underappreciated cause of heart failure. Indeed, several types of viral infections carry cardiovascular risks. Understanding shared and unique mechanisms by which each virus compromises heart function is critical to inform on therapeutic interventions. This review describes how the key viruses known to lead to cardiac dysfunction operate. Both direct host-damaging mechanisms and indirect actions on the immune systems are discussed. As viral myocarditis is a key pathologic driver of heart failure in infected individuals, this review also highlights the role of cytokine storms and inflammation in virus-induced cardiomyopathy.
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15
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Cincin A, Ozben B, Tukenmez Tigen E, Sunbul M, Sayar N, Gurel E, Tigen K, Korten V. Ventricular and atrial functions assessed by speckle-tracking echocardiography in patients with human immunodeficiency virus. JOURNAL OF CLINICAL ULTRASOUND : JCU 2021; 49:341-350. [PMID: 32954546 DOI: 10.1002/jcu.22921] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 07/29/2020] [Accepted: 09/01/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE Antiretroviral therapy (ART) has dramatically changed the clinical manifestation of human immunodeficiency virus (HIV) associated cardiomyopathy from severe left ventricular (LV) systolic dysfunction to a pattern of subclinical cardiac dysfunction. The aim of this study was to evaluate by speckle tracking echocardiography (STE) LV, right ventricular (RV), and biatrial functions in HIV-infected patients under different ART combinations. METHODS We consecutively included 128 HIV-infected patients (mean age 44.2 ± 10.1 years, 110 males) and 100 controls (mean age 42.1 ± 9.4 years, 83 males). Ventricular and atrial functions were assessed by both conventional and STE. RESULTS Although there was not any significant difference in conventional echocardiographic variables, HIV-infected patients had significantly lower LV global longitudinal strain (GLS), RV GLS, left atrial (LA) reservoir and conduit strain, and right atrial conduit strain. HIV patients receiving integrase strand transfer inhibitors and protease inhibitors (PI) had significantly lower LV GLS and LA conduit strain, while patients receiving non-nucleoside reverse transcriptase inhibitors and PI had significantly lower RV GLS than controls. CD4 count at the time of echocardiography was strongly correlated with LV GLS (r = .619, P < .001) and RV GLS (r = .606, P < .001). CONCLUSION Biventricular and atrial functions are subclinically impaired in HIV-infected patients. ART regimen may also affect myocardial functions.
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Affiliation(s)
- Altug Cincin
- Marmara University School of Medicine Department of Cardiology, Istanbul, Turkey
| | - Beste Ozben
- Marmara University School of Medicine Department of Cardiology, Istanbul, Turkey
| | - Elif Tukenmez Tigen
- Marmara University School of Medicine Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - Murat Sunbul
- Marmara University School of Medicine Department of Cardiology, Istanbul, Turkey
| | - Nurten Sayar
- Marmara University School of Medicine Department of Cardiology, Istanbul, Turkey
| | - Emre Gurel
- Marmara University School of Medicine Department of Cardiology, Istanbul, Turkey
| | - Kursat Tigen
- Marmara University School of Medicine Department of Cardiology, Istanbul, Turkey
| | - Volkan Korten
- Marmara University School of Medicine Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
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16
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Narla VA. Sudden cardiac death in HIV-infected patients: A contemporary review. Clin Cardiol 2021; 44:316-321. [PMID: 33594682 PMCID: PMC7943896 DOI: 10.1002/clc.23568] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 02/03/2021] [Indexed: 11/25/2022] Open
Abstract
HIV‐infected individuals have an increased risk of sudden cardiac death compared to the general population; yet the mechanisms underlying this increased risk remain unclear. The mechanisms underlying the heightened sudden cardiac death risk in HIV‐infected individuals is likely multifactorial. We reviewed the literature to elucidate and summarize the potential mechanisms contributing to sudden cardiac death in the HIV patient population. There is biologic plausibility that the following mechanisms may be contributing to the significantly heightened risk of sudden cardiac death in HIV to varying degrees: ventricular arrhythmias, myocardial fibrosis and scar, prolonged QTc interval (both as a direct effect of HIV on repolarization as well as a result of concurrent medications/antiretroviral therapies), substance abuse, structural heart disease, and premature atherosclerosis. Further understanding of the mechanisms underlying the increased sudden cardiac death risk in HIV can lead to identification of modifiable risk factors, implementation of public health programs, and potential revision of ICD implantation guidelines to ultimately reduce the incidence of sudden cardiac death in HIV‐infected patients. Further studies are needed to assess the relative contribution of each of these mechanisms and risk factors.
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Affiliation(s)
- Venkata A Narla
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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17
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Ashwitha SK, Jacob PA, Ajaj A, Shirke MM, Harky A. Management of cardiovascular diseases in HIV/AIDS patients. J Card Surg 2020; 36:236-243. [PMID: 33225472 DOI: 10.1111/jocs.15213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 11/09/2020] [Indexed: 11/30/2022]
Abstract
Human immunodeficiency virus (HIV) infection/acquired immunodeficiency syndrome, a pandemic in the current population causes severe weakness of the body's immune system making the infected patient more vulnerable to life-threatening conditions. The disease predisposes the infected patient to several cardiovascular diseases and cerebrovascular diseases such as heart failure and stroke. The decline in CD4 cells following HIV infection, vulnerability to opportunistic infections and underlying HIV pathology plays a major role in the development of cardiovascular manifestations, and treatment targeting cardiomyopathy in this specific patient subset is not well recognized. Patients living with HIV (PLWH) also experience discrimination in receiving cardiovascular disease care and this needs to be addressed by strengthening frameworks for monitoring and providing nonjudgmental healthcare. This review aims to study the profile of the cardiovascular disease in HIV patients, treatment, and provide evidence of the disparity in the provision of healthcare with regard to PLWH.
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Affiliation(s)
- Santoshi K Ashwitha
- Department of Medicine, School of Medicine, Queen's University Belfast, Belfast, UK
| | - Preethi A Jacob
- Department of Medicine, School of Medicine, Queen's University Belfast, Belfast, UK
| | - Abdullah Ajaj
- Department of Medicine, School of Medicine, Queen's University Belfast, Belfast, UK
| | - Manasi M Shirke
- Department of Medicine, School of Medicine, Queen's University Belfast, Belfast, UK
| | - Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK.,Liverpool Heart and Chest Hospital, Department of Cardiovascular Science, University of Liverpool, Liverpool, UK.,Department of Cardiac Surgery, Alder Hey Children Hospital, Liverpool, UK
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18
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So-Armah K, Benjamin LA, Bloomfield GS, Feinstein MJ, Hsue P, Njuguna B, Freiberg MS. HIV and cardiovascular disease. Lancet HIV 2020; 7:e279-e293. [PMID: 32243826 DOI: 10.1016/s2352-3018(20)30036-9] [Citation(s) in RCA: 124] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 01/27/2020] [Accepted: 01/28/2020] [Indexed: 12/24/2022]
Abstract
HIV-related cardiovascular disease research is predominantly from Europe and North America. Of the estimated 37·9 million people living with HIV worldwide, 25·6 million live in sub-Saharan Africa. Although mechanisms for HIV-related cardiovascular disease might be the same in all people with HIV, the distribution of cardiovascular disease risk factors varies by geographical location. Sub-Saharan Africa has a younger population, higher prevalence of elevated blood pressure, lower smoking rates, and lower prevalence of elevated cholesterol than western Europe and North America. These variations mean that the profile of cardiovascular disease differs between low-income and high-income countries. Research in, implementation of, and advocacy for risk reduction of cardiovascular disease in the global context of HIV should account for differences in the distribution of traditional cardiovascular disease risk factors (eg, hypertension, smoking), consider non-traditional cardiovascular disease risk factors (eg, access to antiretroviral therapy with more benign cardiovascular disease side effect profiles, indoor air pollution), and encourage the inclusion of relevant risk reduction approaches for cardiovascular disease in HIV-care guidelines. Future research priorities include implementation science to scale up and expand integrated HIV and cardiovascular disease care models, which have shown promise in sub-Saharan Africa; HIV and cardiovascular disease epidemiology and mechanisms in women; and tobacco cessation for people living with HIV.
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Affiliation(s)
- Kaku So-Armah
- Boston University School of Medicine, Boston, MA, USA.
| | - Laura A Benjamin
- UCL Queen Square Institute of Neurology, University College London, London, UK; Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | - Gerald S Bloomfield
- Duke Global Health Institute, Duke University, Durham, North Carolina, NC, USA
| | | | | | | | - Matthew S Freiberg
- Vanderbilt University Medical Center, Nashville VA Medical Center, VA Tennessee Valley Healthcare System, Nashville, TN, USA
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19
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Badura R, Foxall RB, Ligeiro D, Rocha M, Godinho-Santos A, Trombetta AC, Sousa AE. Early ART in Acute HIV-1 Infection: Impact on the B-Cell Compartment. Front Cell Infect Microbiol 2020; 10:347. [PMID: 32766164 PMCID: PMC7378391 DOI: 10.3389/fcimb.2020.00347] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 06/05/2020] [Indexed: 12/26/2022] Open
Abstract
HIV-1 infection induces B cell defects, not fully recovered upon antiretroviral therapy (ART). Acute infection and the early start of ART provide unique settings to address the impact of HIV on the B cell compartment. We took advantage of a cohort of 21 seroconverters, grouped according to the presence of severe manifestations likely mediated by antibodies or immune complexes, such as Guillain-Barré syndrome and autoimmune thrombocytopenic purpura, with a follow-up of 8 weeks upon effective ART. We combined B and T cell phenotyping with serum immunoglobulin level measurement and quantification of sj-KRECs and ΔB to estimate bone marrow output and peripheral proliferative history of B cells, respectively. We observed marked B cell disturbances, notably a significant expansion of cells expressing low levels of CD21, in parallel with markers of both impaired bone marrow output and increased peripheral B cell proliferation. This B cell dysregulation is likely to contribute to the severe immune-mediated conditions, as attested by the higher serum IgG and the reduced levels of sj-KRECs with increased ΔB in these individuals as compared to those patients with mild disease. Nevertheless, upon starting ART, the dynamic of B cell recovery was not distinct in the two groups, featuring both persistent alterations by week 8. Overall, we showed for the first time that acute HIV-1 infection is associated with decreased bone marrow B cell output assessed by sj-KRECs. Our study emphasizes the need to intervene in both bone marrow and peripheral responses to facilitate B cell recovery during acute HIV-1 infection.
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Affiliation(s)
- Robert Badura
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,Serviço de Doenças Infecciosas, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Russell B Foxall
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Dario Ligeiro
- Centro de Sangue e Transplantação de Lisboa, Instituto Português de Sangue e Transplantação, IP, Lisbon, Portugal
| | - Miguel Rocha
- Grupo de Ativistas em Tratamentos, Community Based Center for HIV and STD, CheckpointLX, Lisbon, Portugal
| | - Ana Godinho-Santos
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Amelia C Trombetta
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Ana E Sousa
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
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20
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Deconstructing Syndemics: The Many Layers of Clustering Multi-Comorbidities in People Living with HIV. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17134704. [PMID: 32629920 PMCID: PMC7369980 DOI: 10.3390/ijerph17134704] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/19/2020] [Accepted: 06/23/2020] [Indexed: 12/14/2022]
Abstract
The HIV epidemic has dramatically changed over the past 30 years; there are now fewer newly infected people (especially children), fewer AIDS-related deaths, and more people with HIV (PWH) receiving treatment. However, the HIV epidemic is far from over. Despite the tremendous advances in anti-retroviral therapies (ART) and the implementation of ART regimens, HIV incidence (number of new infections over a defined period of time) and prevalence (the burden of HIV infection) in certain regions of the world and socio-economic groups are still on the rise. HIV continues to disproportionally affect highly marginalized populations that constitute higher-risk and stigmatized groups, underserved and/or neglected populations. In addition, it is not uncommon for PWH to suffer enhanced debilitating conditions resulting from the synergistic interactions of both communicable diseases (CDs) and non-communicable diseases (NCDs). While research utilizing only a comorbidities framework has advanced our understanding of the biological settings of the co-occurring conditions from a molecular and mechanistic view, harmful interactions between comorbidities are often overlooked, particularly under adverse socio-economical and behavioral circumstances, likely prompting disease clustering in PWH. Synergistic epidemics (syndemics) research aims to capture these understudied interactions: the mainly non-biological aspects that are central to interpret disease clustering in the comorbidities/multi-morbidities only framework. Connecting population-level clustering of social and health problems through syndemic interventions has proved to be a critical knowledge gap that will need to be addressed in order to improve prevention and care strategies and bring us a step closer to ending the HIV epidemic.
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21
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Association of HIV Infection and Antiretroviral Therapy With Sudden Cardiac Death. J Acquir Immune Defic Syndr 2020; 82:468-474. [PMID: 31714425 DOI: 10.1097/qai.0000000000002161] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND HIV infection potentially increases coronary artery disease and heart failure risks. However, the association between HIV infection and sudden cardiac death (SCD) has not been extensively studied. This nationwide cohort study aimed to determine SCD risks in Taiwanese patients with and without HIV infection. METHODS Adult people living with HIV/AIDS (PLWHA) since January 1, 2003, were identified from the Taiwan Centers for Disease Control HIV surveillance system. HIV-infected individuals were defined as positive HIV-1 Western blot. A control cohort without HIV infection, matched for age and sex, was selected for comparison from the Taiwan National Health Insurance Research Database. All patients were followed up until SCD, mortality for another cause, or till December 31, 2014. A time-dependent Cox proportional hazards model was used to determine the association of HIV and antiretroviral therapy (ART) with SCD. RESULTS During a mean 5.86-year follow-up, 5342 (4.40%) of 121,530 patients (24,306 PLWHA and 97,224 matched controls) died; among them, 150 (0.12%) died of SCD. Among 150 SCD events, 97 (64.7%) and 53 (33.3%) occurred in PLWHA and controls, respectively, which corresponded to incidences of 68.31 in PLWHA and 9.31 per 100,000 person-years in controls (P < 0.001). After adjusting for age, sex, and comorbidities, HIV infection was an independent risk factor for SCD (adjusted hazard ratio, 8.15; 95% confidence interval: 5.58 to 11.90). SCD incidence was significantly lower in PLWHA receiving ART (adjusted hazard ratio 0.53; 95% confidence interval: 0.32 to 0.87). CONCLUSIONS HIV infection is an independent risk factor for SCD. SCD rates are low in PLWHA receiving ART.
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22
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Echocardiographic Follow-up of Perinatally HIV-infected Children and Adolescents: Results From a Single-center Retrospective Cohort Study in Brazil. Pediatr Infect Dis J 2020; 39:526-532. [PMID: 32412728 DOI: 10.1097/inf.0000000000002628] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The effects of HIV and antiretroviral therapy on cardiovascular system of perinatally infected children throughout their development are not fully understood. OBJECTIVES To determine the prevalence of cardiac abnormalities in a retrospective cohort of perinatally HIV-infected patients and to investigate associations between echocardiographic and clinical data during their follow-up. METHODS Review of medical records and echocardiogram reports of 148 perinatally HIV-infected patients between January 1991 and December 2015. RESULTS Four hundred and eighty echocardiograms were analyzed and 46 (31%) patients showed cardiac abnormalities, frequently subclinical and transient. Nadir CD4 count was higher in patients with consistently normal echocardiogram: 263 (4-1480) versus 202 (5-1746) cells/μL, P = 0.021. Right ventricular (RV) dilation was detected in 18.9%, left ventricular (LV) dilation in 21.6%, septal hypertrophy in 12.2%, LV posterior wall hypertrophy in 6%, LV systolic dysfunction in 8% and pulmonary hypertension in 8.7% of patients. Opportunistic infections were associated with RV dilation [odds ratio (OR = 4.34; 1.78-10.53; P < 0.01)], pulmonary hypertension (OR = 8.78; 2.80-27.51; P < 0.01) and LV systolic dysfunction (OR = 5.38; 1.55-18.71; P < 0.01). Longer duration of highly active antiretroviral therapy was associated with reduced risk of LV dilation (OR = 0.91; 0.85-0.97; P < 0.01) and systolic dysfunction (OR = 0.71; 0.59-0.85; P < 0.01). Protease inhibitors use was associated with reduced risk of RV dilation (OR = 0.54; 0.30-0.97; P < 0.05), LV dilation (OR = 0.35; 0.21-0.60; P < 0.01) and LV systolic dysfunction (OR = 0.07; 0.02-0.31; P < 0.01). Higher CD4 count was associated with lower risk of LV systolic dysfunction (OR = 0.82; 0.69-0.98; P < 0.05). CONCLUSIONS Echocardiograms identified cardiac abnormalities among children with perinatally acquired HIV infection, and data suggest that immunologic status and therapeutic strategies throughout development can influence cardiac disease burden in this population.
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23
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Rroku A, Kottwitz J, Heidecker B. Update on myocarditis - what we know so far and where we may be heading. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2020; 10:2048872620910109. [PMID: 32319308 DOI: 10.1177/2048872620910109] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Affiliation(s)
- Andi Rroku
- Charite Universitätsmedizin Berlin, Campus Benjamin Franklin, Germany
| | | | - Bettina Heidecker
- Charite Universitätsmedizin Berlin, Campus Benjamin Franklin, Germany
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24
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Erqou S, Jiang L, Choudhary G, Lally M, Bloomfield GS, Zullo AR, Shireman TI, Freiberg M, Justice AC, Rudolph J, Lin N, Wu WC. Heart Failure Outcomes and Associated Factors Among Veterans With Human Immunodeficiency Virus Infection. JACC-HEART FAILURE 2020; 8:501-511. [PMID: 32278680 DOI: 10.1016/j.jchf.2019.12.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 12/29/2019] [Accepted: 12/30/2019] [Indexed: 01/06/2023]
Abstract
OBJECTIVES This study sought to investigate outcomes of heart failure (HF) in veterans living with human immunodeficiency virus (HIV). BACKGROUND Data on outcomes of HF among people living with human immunodeficiency virus (PLHIV) are limited. METHODS We performed a retrospective cohort study of Veterans Health Affairs data to investigate outcomes of HF in PLHIV. We identified 5,747 HIV+ veterans with diagnosis of HF from 2000 to 2018 and 33,497 HIV- frequency-matched controls were included. Clinical outcomes included all-cause mortality, HF hospital admission, and all-cause hospital admission. RESULTS Compared with HIV- veterans with HF, HIV+ veterans with HF were more likely to be black (56% vs. 14%), be smokers (52% vs. 29%), use alcohol (32% vs. 13%) or drugs (37% vs. 8%), and have a higher comorbidity burden (Elixhauser comorbidity index 5.1 vs. 2.6). The mean ejection fraction (EF) (45 ± 16%) was comparable between HIV+ and HIV- veterans. HIV+ veterans with HF had a higher age-, sex-, and race-adjusted 1-year all-cause mortality (30.7% vs. 20.3%), HF hospital admission (21.2% vs. 18.0%), and all-cause admission (50.2% vs. 38.5%) rates. Among veterans with HIV and HF, those with low CD4 count (<200 cells/ml) and high HIV viral load (>75 copies/μl) had worse outcomes. The associations remained statistically significant after adjusting for extensive list of covariates. The incidence of all-cause mortality and HF admissions was higher among HIV+ veterans with ejection fraction <45% CONCLUSIONS: HIV+ veterans with HF had higher risk of hospitalization and mortality compared with their HIV- counterparts, with worse outcomes reported for individuals with lower CD4 count, higher viral load, and lower ejection fraction.
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Affiliation(s)
- Sebhat Erqou
- Providence VA Medical Center, Providence, Rhode Island; Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island.
| | - Lan Jiang
- Providence VA Medical Center, Providence, Rhode Island
| | - Gaurav Choudhary
- Providence VA Medical Center, Providence, Rhode Island; Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Michelle Lally
- Providence VA Medical Center, Providence, Rhode Island; Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Gerald S Bloomfield
- Duke Clinical Research Institute, Duke Global Health Institute and Department of Medicine, Duke University, Durham, North Carolina
| | - Andrew R Zullo
- Providence VA Medical Center, Providence, Rhode Island; Center for Gerontology & Health Care Research and Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Theresa I Shireman
- Center for Gerontology & Health Care Research and Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Mathew Freiberg
- Department of Medicine, Vanderbilt University, Nashville, Tennessee
| | - Amy C Justice
- Department of Medicine, Yale University, New Haven, Connecticut; VA Connecticut Healthcare System, West Haven, Connecticut
| | - James Rudolph
- Providence VA Medical Center, Providence, Rhode Island; Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island; Center for Gerontology & Health Care Research and Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Nina Lin
- Department of Medicine, Boston University, Boston, Massachusetts
| | - Wen-Chih Wu
- Providence VA Medical Center, Providence, Rhode Island; Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island
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Erqou S, Lodebo BT, Masri A, Altibi AM, Echouffo-Tcheugui JB, Dzudie A, Ataklte F, Choudhary G, Bloomfield GS, Wu WC, Kengne AP. Cardiac Dysfunction Among People Living With HIV: A Systematic Review and Meta-Analysis. JACC-HEART FAILURE 2020; 7:98-108. [PMID: 30704613 DOI: 10.1016/j.jchf.2018.10.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Revised: 09/26/2018] [Accepted: 10/04/2018] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To synthesize existing epidemiological data on cardiac dysfunction in HIV. BACKGROUND Data on the burden and risk of human immunodeficiency virus (HIV) infection-associated cardiac dysfunction have not been adequately synthesized. We performed meta-analyses of extant literature on the frequency of several subtypes of cardiac dysfunction among people living with HIV. METHODS We searched electronic databases and reference lists of review articles and combined the study-specific estimates using random-effects model meta-analyses. Heterogeneity was explored using subgroup analyses and meta-regressions. RESULTS We included 63 reports from 54 studies comprising up to 125,382 adults with HIV infection and 12,655 cases of various cardiac dysfunctions. The pooled prevalence (95% confidence interval) was 12.3% (6.4% to 19.7%; 26 studies) for left ventricular systolic dysfunction (LVSD); 12.0% (7.6% to 17.2%; 17 studies) for dilated cardiomyopathy; 29.3% (22.6% to 36.5%; 20 studies) for grades I to III diastolic dysfunction; and 11.7% (8.5% to 15.3%; 11 studies) for grades II to III diastolic dysfunction. The pooled incidence and prevalence of clinical heart failure were 0.9 per 100 person-years (0.4 to 2.1 per 100 person-years; 4 studies) and 6.5% (4.4% to 9.6%; 8 studies), respectively. The combined prevalence of pulmonary hypertension and right ventricular dysfunction were 11.5% (5.5% to 19.2%; 14 studies) and 8.0% (5.2% to 11.2%; 10 studies), respectively. Significant heterogeneity was observed across studies for all the outcomes analyzed (I2 > 70%, p < 0.01), only partly explained by available study level characteristics. There was a trend for lower prevalence of LVSD in studies reporting higher antiretroviral therapy use or lower proportion of acquired immune deficiency syndrome. The prevalence of LVSD was higher in the African region. After taking into account the effect of regional variation, there was evidence of lower prevalence of LVSD in studies published more recently. CONCLUSIONS Cardiac dysfunction is frequent in people living with HIV. Additional prospective studies are needed to better understand the burden and risk of various forms of cardiac dysfunction related to HIV and the associated mechanisms. (Cardiac dysfunction in people living with HIV-a systematic review and meta-analysis; CRD42018095374).
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Affiliation(s)
- Sebhat Erqou
- Department of Medicine, Providence VA Medical Center, Providence, Rhode Island; Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island.
| | | | - Ahmad Masri
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania. https://twitter.com/MasriAhmadMD
| | - Ahmed M Altibi
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Anastase Dzudie
- Faculty of Medicine and Biomedical Sciences, University of Yaounde, Yaounde, Cameroon
| | - Feven Ataklte
- Department of Medicine, Boston University, Boston, Massachusetts
| | - Gaurav Choudhary
- Department of Medicine, Providence VA Medical Center, Providence, Rhode Island; Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island. https://twitter.com/GChoudharyMD
| | - Gerald S Bloomfield
- Duke Clinical Research Institute, Duke Global Health Institute and Department of Medicine, Duke University, Durham, North Carolina
| | - Wen-Chih Wu
- Department of Medicine, Providence VA Medical Center, Providence, Rhode Island; Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Andre Pascal Kengne
- South African Medical Research Council and University of Cape Town, South Africa
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Dominick L, Midgley N, Swart LM, Sprake D, Deshpande G, Laher I, Joseph D, Teer E, Essop MF. HIV-related cardiovascular diseases: the search for a unifying hypothesis. Am J Physiol Heart Circ Physiol 2020; 318:H731-H746. [PMID: 32083970 DOI: 10.1152/ajpheart.00549.2019] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Although the extensive rollout of antiretroviral (ARV) therapy resulted in a longer life expectancy for people living with human immunodeficiency virus (PLHIV), such individuals display a relatively increased occurrence of cardiovascular diseases (CVD). This health challenge stimulated significant research interests in the field, leading to an improved understanding of both lifestyle-related risk factors and the underlying mechanisms of CVD onset in PLHIV. However, despite such progress, the precise role of various risk factors and mechanisms underlying the development of HIV-mediated CVD still remains relatively poorly understood. Therefore, we review CVD onset in PLHIV and focus on 1) the spectrum of cardiovascular complications that typically manifest in such persons and 2) underlying mechanisms that are implicated in this process. Here, the contributions of such factors and modulators and underlying mechanisms are considered in a holistic and integrative manner to generate a unifying hypothesis that includes identification of the core pathways mediating CVD onset. The review focuses on the sub-Saharan African context, as there are relatively high numbers of PLHIV residing within this region, indicating that the greater CVD risk will increasingly threaten the well-being and health of its citizens. It is our opinion that such an approach helps point the way for future research efforts to improve treatment strategies and/or lifestyle-related modifications for PLHIV.
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Affiliation(s)
- Leanne Dominick
- Centre for Cardio-metabolic Research in Africa, Department of Physiological Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Natasha Midgley
- Centre for Cardio-metabolic Research in Africa, Department of Physiological Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Lisa-Mari Swart
- Centre for Cardio-metabolic Research in Africa, Department of Physiological Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Devon Sprake
- Centre for Cardio-metabolic Research in Africa, Department of Physiological Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Gaurang Deshpande
- Centre for Cardio-metabolic Research in Africa, Department of Physiological Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Ismail Laher
- Centre for Cardio-metabolic Research in Africa, Department of Physiological Sciences, Stellenbosch University, Stellenbosch, South Africa.,Department of Anesthesiology, Pharmacology, and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Danzil Joseph
- Centre for Cardio-metabolic Research in Africa, Department of Physiological Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Eman Teer
- Centre for Cardio-metabolic Research in Africa, Department of Physiological Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - M Faadiel Essop
- Centre for Cardio-metabolic Research in Africa, Department of Physiological Sciences, Stellenbosch University, Stellenbosch, South Africa
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Eosinophils, Lymphocytes, and Myocytes, Oh My: HIV-Associated Myocarditis. Am J Med 2020; 133:52-55. [PMID: 31251904 DOI: 10.1016/j.amjmed.2019.05.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 05/10/2019] [Accepted: 05/12/2019] [Indexed: 11/21/2022]
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Ponomareva EY, Eliseeva SP, Dorogoykina KD. [Dilated cardiomyopathyDilated Cardiomyopathy Associated with HIV Infection associated with HIV infection]. ACTA ACUST UNITED AC 2019; 59:95-100. [PMID: 31849304 DOI: 10.18087/cardio.2019.11.n554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 06/07/2019] [Accepted: 06/26/2019] [Indexed: 11/18/2022]
Abstract
We present here the case of development of dilated cardiomyopathy in a patient with HIV infection. The results of dynamic monitoring and treatment (cardiotropic and antiretroviral therapy) for 4 years are described. We also discuss literature data on the frequency of dilated cardiomyopathy development in HIV infection, on key aspects of its pathogenesis, specific features of the course, and approaches to therapy.
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Affiliation(s)
- E Y Ponomareva
- Saratov State Medical University named after V.I. Razumovsky
| | | | - K D Dorogoykina
- Saratov State Medical University named after V.I. Razumovsky
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29
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Alvarado GR, Usry CR, Gore RS, Watts JA, Okulicz JF. Echocardiographic assessment of asymptomatic US Air Force members with early HIV infection. BMC Res Notes 2019; 12:783. [PMID: 31783911 PMCID: PMC6884824 DOI: 10.1186/s13104-019-4822-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 11/24/2019] [Indexed: 01/11/2023] Open
Abstract
Objective People living with HIV (PLHIV) are at increased risk for cardiovascular disease (CVD) and development of subclinical echocardiographic abnormalities. However, there is scant evidence of the echocardiographic changes that occur shortly after seroconversion. In this study we describe the echocardiographic evaluations of asymptomatic US Air Force members who were diagnosed with HIV infection and evaluated at the San Antonio Military Medical Center between September 1, 2015 and September 30, 2016. Results Patients (n = 50) were predominantly male (96%), mostly African American (60%), with a mean age of 28 years. At HIV diagnosis, the mean viral load was 112,585 copies/mL and CD4 count was 551 cells/μL. All were found to have normal left ventricular systolic ejection fraction (EF) and global longitudinal strain (GLS) however evidence of right ventricular dilatation and left ventricular remodeling was observed in 7 (14%) and 13 (26%) patients, respectively. Subgroup analyses showed no significant differences in echocardiographic findings by HIV disease severity or CVD risk factors (p > 0.05 for all).This study suggests that untreated HIV may have a low impact on the development of echocardiographic abnormalities shortly after seroconversion. Longitudinal studies are warranted to determine the optimal CVD risk assessment strategies for PLHIV.
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Affiliation(s)
- Gadiel R Alvarado
- Infectious Disease Department, San Antonio Military Medical Center, San Antonio, TX, 78234, USA.
| | - Courtney R Usry
- Cardiology Department, San Antonio Military Medical Center, San Antonio, TX, USA
| | - Rosco S Gore
- Cardiology Department, San Antonio Military Medical Center, San Antonio, TX, USA
| | - James A Watts
- Cardiology Department, San Antonio Military Medical Center, San Antonio, TX, USA
| | - Jason F Okulicz
- Infectious Disease Department, San Antonio Military Medical Center, San Antonio, TX, 78234, USA
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30
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Brayson D, Frustaci A, Verardo R, Chimenti C, Russo MA, Hayward R, Ahmad S, Vizcay-Barrena G, Protti A, Zammit PS, dos Remedios CG, Ehler E, Shah AM, Shanahan CM. Prelamin A mediates myocardial inflammation in dilated and HIV-associated cardiomyopathies. JCI Insight 2019; 4:126315. [PMID: 31622279 PMCID: PMC6948859 DOI: 10.1172/jci.insight.126315] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 10/08/2019] [Indexed: 12/13/2022] Open
Abstract
Cardiomyopathies are complex heart muscle diseases that can be inherited or acquired. Dilated cardiomyopathy can result from mutations in LMNA, encoding the nuclear intermediate filament proteins lamin A/C. Some LMNA mutations lead to accumulation of the lamin A precursor, prelamin A, which is disease causing in a number of tissues, yet its impact upon the heart is unknown. Here, we discovered myocardial prelamin A accumulation occurred in a case of dilated cardiomyopathy, and we show that a potentially novel mouse model of cardiac-specific prelamin A accumulation exhibited a phenotype consistent with inflammatory cardiomyopathy, which we observed to be similar to HIV-associated cardiomyopathy, an acquired disease state. Numerous HIV protease therapies are known to inhibit ZMPSTE24, the enzyme responsible for prelamin A processing, and we confirmed that accumulation of prelamin A occurred in HIV+ patient cardiac biopsies. These findings (a) confirm a unifying pathological role for prelamin A common to genetic and acquired cardiomyopathies; (b) have implications for the management of HIV patients with cardiac disease, suggesting protease inhibitors should be replaced with alternative therapies (i.e., nonnucleoside reverse transcriptase inhibitors); and (c) suggest that targeting inflammation may be a useful treatment strategy for certain forms of inherited cardiomyopathy.
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Affiliation(s)
- Daniel Brayson
- School of Cardiovascular Medicine and Sciences, King's College London BHF Centre for Research Excellence, London, United Kingdom
| | - Andrea Frustaci
- Department of Cardiovascular, Nefrologic, Anestesiologic and Geriatric Sciences, La Sapienza University of Rome, Italy.,National Institute for Infectious Diseases IRCCS "L. Spallanzani", Rome, Italy
| | - Romina Verardo
- National Institute for Infectious Diseases IRCCS "L. Spallanzani", Rome, Italy
| | - Cristina Chimenti
- Department of Cardiovascular, Nefrologic, Anestesiologic and Geriatric Sciences, La Sapienza University of Rome, Italy.,National Institute for Infectious Diseases IRCCS "L. Spallanzani", Rome, Italy
| | - Matteo Antonio Russo
- MEBIC Open University San Raffaele and IRCCS San Raffaele Pisana, Laboratory of Molecular and Cellular Pathology, Milan, Italy
| | - Robert Hayward
- School of Cardiovascular Medicine and Sciences, King's College London BHF Centre for Research Excellence, London, United Kingdom
| | - Sadia Ahmad
- School of Cardiovascular Medicine and Sciences, King's College London BHF Centre for Research Excellence, London, United Kingdom
| | | | - Andrea Protti
- School of Cardiovascular Medicine and Sciences, King's College London BHF Centre for Research Excellence, London, United Kingdom
| | - Peter S Zammit
- Randall Centre for Cell and Molecular Biophysics, King's College London, London, United Kingdom
| | | | - Elisabeth Ehler
- School of Cardiovascular Medicine and Sciences, King's College London BHF Centre for Research Excellence, London, United Kingdom.,Randall Centre for Cell and Molecular Biophysics, King's College London, London, United Kingdom
| | - Ajay M Shah
- School of Cardiovascular Medicine and Sciences, King's College London BHF Centre for Research Excellence, London, United Kingdom
| | - Catherine M Shanahan
- School of Cardiovascular Medicine and Sciences, King's College London BHF Centre for Research Excellence, London, United Kingdom
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Butler J, Greene SJ, Shah SH, Shah SJ, Anstrom KJ, Kim RJ, Kalogeropoulos AP, Velazquez EJ, Hernandez AF, Desvigne-Nickens P, Scherzer R, Hsue PY, Braunwald E. Diastolic Dysfunction in Patients With Human Immunodeficiency Virus Receiving Antiretroviral Therapy: Results From the CHART Study. J Card Fail 2019; 26:371-380. [PMID: 31682908 DOI: 10.1016/j.cardfail.2019.10.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 10/14/2019] [Accepted: 10/25/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Diastolic dysfunction (DD) is common and occurs at an earlier age among human immunodeficiency virus-infected (HIV+) individuals, but the mechanisms and consequences of DD among HIV+ individuals are unclear. METHODS AND RESULTS The Characterization of Heart Function on Antiretroviral Therapy (CHART) study was a multicenter cross-sectional case-control study of treated and virally suppressed HIV+ individuals with (DD+) and without DD (DD-). All patients had normal ejection fraction (>50%), no significant valvular disease, and no history of coronary revascularization or persistent atrial fibrillation. Overall, 94 DD+ and 101 DD- patients were included. DD+ patients were older with higher body mass index (BMI) and more likely to have hypertension, renal dysfunction, and dyslipidemia. Groups were similar with respect to sex, race, CD4 count, and HIV RNA copies. N-terminal pro-B-type natriuretic peptide levels (median 36 [23, 85] vs 26 [12, 49] pg/mL, P < .01) and high-sensitivity troponin I (3.6 [2.6, 5.1] vs 2.5 [1.8, 3.5] pg/mL, P < .01) were higher among DD+ patients. The latter had similar left atrial size, but increased stiffness (conduit strain: 23.5 [17.5, 36.9] vs 30.0 [22.9, 37.0], P < .01) and impaired relaxation (reservoir strain: 39.7 [32.0, 58.0] vs 45.9 [37.0, 60.6], P = .04). On cardiac magnetic resonance, the prevalence of focal fibrosis was higher among DD+ patients (19.0% vs 5.3%, P < .01). DD+ patients demonstrated higher levels of carboxyl-terminal telopeptide of collagen type I (P = .04), and trends toward higher interleukin-6 and oxidized low-density lipoprotein levels (P ≤ .08). Kansas City Cardiomyopathy Questionnaire physical limitation (87.1±21.4 vs 93.1±18.1, P = .01) and symptom frequency scores were lower among DD+ patients (86.0±21.5 vs 92.5±16.8, P = .01). CONCLUSIONS In this contemporary HIV+ population receiving antiretroviral therapy, DD was associated with multiple alterations in cardiac structure and function, including myocardial fibrosis and left atrial abnormalities, and worse quality of life. Further studies are needed to assess longitudinal changes in these parameters and their potential as therapeutic targets to prevent progressive cardiac remodeling and dysfunction in HIV.
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Affiliation(s)
- Javed Butler
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi.
| | - Stephen J Greene
- Duke Clinical Research Institute, Durham, North Carolina; Division of Cardiology, Duke University School of Medicine, Durham, North Carolina
| | - Svati H Shah
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina
| | - Sanjiv J Shah
- Division of Cardiology, Northwestern Feinberg School of Medicine, Chicago, Illinois
| | | | - Raymond J Kim
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina
| | | | - Eric J Velazquez
- Division of Cardiology, Yale University School of Medicine, New Haven, Connecticut
| | - Adrian F Hernandez
- Duke Clinical Research Institute, Durham, North Carolina; Division of Cardiology, Duke University School of Medicine, Durham, North Carolina
| | - Patrice Desvigne-Nickens
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Rebecca Scherzer
- Department of Medicine, University of California San Francisco and San Francisco Department of Veterans Administration, San Francisco, California
| | - Priscilla Y Hsue
- Division of Cardiology, University of California San Francisco, San Francisco, California
| | - Eugene Braunwald
- TIMI Study Group, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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32
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Capotosto L, D'Ettorre G, Ajassa C, Cavallari N, Ciardi MR, Placanica G, Ricci S, Lucchetti P, Tanzilli G, Mangieri E, Gaudio C, Vullo V, Vitarelli A. Assessment of Biventricular Function by Three-Dimensional Speckle Tracking Echocardiography in Adolescents and Young Adults with Human Immunodeficiency Virus Infection: A Pilot Study. Cardiology 2019; 144:101-111. [PMID: 31614346 DOI: 10.1159/000503140] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 09/03/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND The purpose of the study was to assess biventricular parameters of wall deformation with three-dimensional speckle tracking echocardiography (3DSTE) in adolescents and young adults with human immunodeficiency virus (HIV) infection on antiretroviral therapy in order to detect a possible subclinical myocardial dysfunction. METHODS Twenty-one patients aged 12-39 years with HIV, 21 normal controls of the same age and sex, and 21 patients with idiopathic nonischemic dilated cardiomyopathy (DCM) were studied with 3DSTE. All HIV patients were stable in terms of HIV infection, with no history of heart disease or other chronic systemic disease except HIV infection, and were on highly active antiretroviral therapy with good immunological control. Standard echocardiographic measures of left ventricular (LV)-right ventricular (RV) function were assessed. 3D LV global longitudinal strain (GLS), circumferential strain, radial strain, and LV twist were calculated. Global area strain (GAS) was calculated by 3DSTE as percentage variation in surface area defined by the longitudinal and circumferential strain vectors. 3D RV global and free-wall longitudinal strain (FWLS) were obtained. RESULTS LV GLS and GAS were lower in HIV patients compared to normal controls (p = 0.002, and p = 0.01, respectively). There were no significant differences in LV ejection fractions between the groups. There was a weak positive correlation between LV GLS and age (r = 0.215, p = 0.034) and a weak negative correlation between LV GLS and nadir-CD4 T-cells count (r = 0.198, p = 0.043). DCM patients had more marked and widespread reduction in LV GLS and GAS compared to controls (p < 0.001), whereas in HIV patients LV strain impairment (p < 0.05) was more localized in basal and apical regions. RV FWLS was significantly reduced in HIV patients when compared with the control group (p = 0.03). No patient had pulmonary systolic pressure higher than 35 mm Hg. CONCLUSIONS 3DSTE may help to identify HIV patients at high cardiovascular risk allowing early detection of biventricular dysfunction in the presence of normal LV ejection fraction and in the absence of pulmonary hypertension. LV strain impairment in HIV patients is less prominent and widespread compared to DCM patients.
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Affiliation(s)
| | | | - Camilla Ajassa
- Department of Infectious Diseases, Sapienza University, Rome, Italy
| | - Nelson Cavallari
- Department of Infectious Diseases, Sapienza University, Rome, Italy
| | | | | | - Serafino Ricci
- Department of Infectious Diseases, Sapienza University, Rome, Italy
| | - Pietro Lucchetti
- Department of Infectious Diseases, Sapienza University, Rome, Italy
| | | | | | - Carlo Gaudio
- Department of Cardiology, Sapienza University, Rome, Italy
| | - Vincenzo Vullo
- Department of Infectious Diseases, Sapienza University, Rome, Italy
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Hutchins E, Wang R, Rahmani S, Nakanishi R, Haberlen S, Kingsley L, Witt MD, Palella FJ, Jacobson L, Budoff MJ, Post WS. HIV Infection Is Associated with Greater Left Ventricular Mass in the Multicenter AIDS Cohort Study. AIDS Res Hum Retroviruses 2019; 35:755-761. [PMID: 31044604 PMCID: PMC6688109 DOI: 10.1089/aid.2019.0014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
HIV infection has been associated with diastolic heart failure and atrial fibrillation. The purpose of this study is to determine whether HIV infection is associated with differences in left ventricular mass (LVM), left ventricular end-diastolic volume (LVEDV), and left atrial volume (LAV) indexed to body surface area (left ventricular mass index, left ventricular end-diastolic volume index [LVEDVI], and left atrial volume index [LAVI], respectively). Cross-sectional study of 721 men [425 HIV-infected (HIV+), 296 HIV-uninfected (HIV-) enrolled in the cardiovascular substudy of the Multicenter AIDS Cohort Study (MACS). Participants underwent cardiac computed tomography imaging. A blinded reader measured LVM, LVEDV, and LAV. We used multivariable linear regression models to evaluate whether LVEDVI, left ventricular mass index (LVMI), and LAVI differed by HIV serostatus, adjusting for demographics and cardiovascular disease risk factors. LVMI was significantly greater in HIV+ compared with HIV- men, with adjusted difference of 2.65 g/m2 (95% confidence interval 0.53-4.77, p < .001). Left ventricular end-diastolic index and LAVI did not differ significantly between the two groups. HIV-related factors (nadir CD4 count, clinical AIDS diagnosis, cumulative antiretroviral therapy use, and cumulative protease inhibitor use) were not significantly associated with LVMI, LVEDVI, or LAVI. LVM was significantly higher in HIV+ than HIV- men, which may contribute to the observed increased risk for diastolic heart failure associated with HIV infection. Although HIV infection has been associated with an increased risk for atrial fibrillation, we did not find any difference in LAV by HIV serostatus.
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Affiliation(s)
| | - Ruibin Wang
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Sina Rahmani
- Los Angeles Biomedical Research Institute, Torrance, California
| | - Rine Nakanishi
- Los Angeles Biomedical Research Institute, Torrance, California
| | - Sabina Haberlen
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Lawrence Kingsley
- Department of Infectious Diseases and Microbiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Mallory D. Witt
- Los Angeles Biomedical Research Institute, Torrance, California
| | - Frank Joseph Palella
- Feinberg School of Medicine, Division of Infectious Diseases, Northwestern University, Chicago, Illinois
| | - Lisa Jacobson
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Wendy S. Post
- Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, Maryland
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Meng Y, Sun T, Wu C, Dong C, Xiong S. Calpain regulates CVB3 induced viral myocarditis by promoting autophagic flux upon infection. Microbes Infect 2019; 22:46-54. [PMID: 31319178 DOI: 10.1016/j.micinf.2019.07.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 06/22/2019] [Accepted: 07/10/2019] [Indexed: 12/18/2022]
Abstract
Calpains are calcium-activated neutral cysteine proteases. The dysregulation of calpain activity has been found to be related to cardiovascular diseases, for which calpain inhibition is used as a treatment. Viral myocarditis (VMC) is primarily caused by Coxsackievirus group B3 virus infection (CVB3). CVB3 virus infection induces autophagy and hijacks this process to facilitate its replication. In this study, we found that calpain was significantly activated in hearts affected by VMC. However, pharmacologically inhibiting calpain aggravated VMC symptoms in mice due to myocardial inflammation and cardiac dysfunction. The inhibition of calpain activity in vitro led to the accumulation of LC3-II and increased levels of p62/SQSTM1 protein expression, suggesting that autophagic flux was impaired by calpain inhibition. These effects of calpain inhibition were also observed in capn4-specific myocardial knockout mice in vivo. Furthermore, our results provided evidence that calpain inhibition in VMC, unlike other cardiovascular diseases, exacerbated the disease symptom by impairing CVB3-induced autophagic flux, which may subsequently reduce virus autolysosome degradation. Our findings indicated that calpain inhibition may not be a good treatment for VMC disease in a clinical setting.
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Affiliation(s)
- Yawen Meng
- Jiangsu Key Laboratory of Infection and Immunity, Institutes of Biology and Medical Sciences, Soochow University, Suzhou, 215123, China
| | - Tianle Sun
- Jiangsu Key Laboratory of Infection and Immunity, Institutes of Biology and Medical Sciences, Soochow University, Suzhou, 215123, China
| | - Chuanjian Wu
- Jiangsu Key Laboratory of Infection and Immunity, Institutes of Biology and Medical Sciences, Soochow University, Suzhou, 215123, China
| | - Chunsheng Dong
- Jiangsu Key Laboratory of Infection and Immunity, Institutes of Biology and Medical Sciences, Soochow University, Suzhou, 215123, China.
| | - Sidong Xiong
- Jiangsu Key Laboratory of Infection and Immunity, Institutes of Biology and Medical Sciences, Soochow University, Suzhou, 215123, China.
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So-Armah K, Freiberg MS. HIV and Cardiovascular Disease: Update on Clinical Events, Special Populations, and Novel Biomarkers. Curr HIV/AIDS Rep 2019; 15:233-244. [PMID: 29752699 DOI: 10.1007/s11904-018-0400-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW The objective of this review is to provide an update on the link between HIV infection and cardiovascular disease (CVD). We will focus our review mainly on literature describing clinical CVD events and understudied topics of importance. RECENT FINDINGS Heart failure, peripheral artery disease, and stroke are CVD modalities deserving more attention in the context of HIV infection in the highly active antiretroviral therapy era. Incidence data on clinical CVD from HIV populations in low- and middle-income countries are limited. Multisubstance use is common in HIV, but understudied as a moderator or mediator of the association between HIV and CVD. CVD risk assessment in HIV remains challenging, but new research into novel biomarkers may provide further insights. There is also a need for inclusion of non-biologic factors in our attempts to understand, quantify, and predict CVD risk among PLWHA. Significant attention has been paid to generating and testing hypotheses to understand the mechanisms of myocardial infarction in HIV. Similar attention is deserving for heart failure, PAD, stroke, and cardiovascular disease risk in resource-limited settings and among substance users with HIV.
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Affiliation(s)
- Kaku So-Armah
- School of Medicine, Boston University, Boston, MA, USA.
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Cardiac status of perinatally HIV-infected children: assessing combination antiretroviral regimens in observational studies. AIDS 2018; 32:2337-2346. [PMID: 30102660 DOI: 10.1097/qad.0000000000001988] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To evaluate potential adverse associations of individual antiretroviral medications used in combination antiretroviral therapy regimens on cardiac structure and function in youth with perinatally-acquired HIV infection (PHIV). DESIGN PHIV youth (N = 325) enrolled in a prospective multisite cohort study had a single echocardiogram at age 7-16 years to evaluate cardiac function and structure. METHODS We applied several statistical approaches to evaluate associations between use of 18 individual antiretroviral medications with Z-scores for 11 measures of left ventricular function and structure. These included simultaneously evaluating all antiretroviral medications in adjusted linear regression models controlling for the false discovery rate (FDR), applying hierarchical models to estimate individual antiretroviral medication effects as deviations from drug class means, and evaluating latent measures of cardiac function and structure underlying multiple echocardiographic parameters. RESULTS Youth taking combination regimens with a protease inhibitor (69%) had significantly better cardiac function than those on other regimens. After FDR control and adjustment for other antiretroviral medications, no individual antiretroviral medication was significantly associated with any measure of left ventricular function, but zidovudine was associated with higher adjusted mean Z-scores for one measure of left ventricular structure (end-systolic wall stress). Factor analysis identified three latent factors: heart function, heart size, and heart wall stress. Lopinavir was associated with better heart function scores, whereas zidovudine was associated with higher wall stress scores. Zidovudine and nevirapine were associated with higher heart size factor scores. CONCLUSIONS Despite cardioprotective effects of combination regimens in PHIV youth, individual antiretroviral medications were associated with altered cardiac structure, which could progress to symptomatic cardiomyopathy in adulthood.
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Tsabedze N, Vachiat A, Zachariah D, Manga P. A New Face of Cardiac Emergencies: Human Immunodeficiency Virus-Related Cardiac Disease. Cardiol Clin 2018; 36:161-170. [PMID: 29173676 DOI: 10.1016/j.ccl.2017.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The human immunodeficiency virus epidemic is a major health challenge of the twenty-first century as the transition from infectious complications to noncommunicable disease becomes more evident. These patients may present to the emergency department with a variety of cardiovascular diseases, such as acute coronary syndromes, heart failure, pericardial disease, infective endocarditis, venothromboembolism, and other conditions. Increased awareness is needed among health care professionals to enhance adequate identification and promote prompt management of these patients.
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Affiliation(s)
- Nqoba Tsabedze
- Division of Cardiology, Department of Internal Medicine, Faculty of Health Sciences, University of Witwatersrand, 7 York Road, Parktown, Johannesburg 2000, South Africa
| | - Ahmed Vachiat
- Division of Cardiology, Department of Internal Medicine, Faculty of Health Sciences, University of Witwatersrand, 7 York Road, Parktown, Johannesburg 2000, South Africa
| | - Don Zachariah
- Division of Cardiology, Department of Internal Medicine, Faculty of Health Sciences, University of Witwatersrand, 7 York Road, Parktown, Johannesburg 2000, South Africa
| | - Pravin Manga
- Division of Cardiology, Department of Internal Medicine, Faculty of Health Sciences, University of Witwatersrand, 7 York Road, Parktown, Johannesburg 2000, South Africa.
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38
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Butler J, Kalogeropoulos AP, Anstrom KJ, Hsue PY, Kim RJ, Scherzer R, Shah SJ, Shah SH, Velazquez EJ, Hernandez AF, Desvigne-Nickens P, Braunwald E. Diastolic Dysfunction in Individuals With Human Immunodeficiency Virus Infection: Literature Review, Rationale and Design of the Characterizing Heart Function on Antiretroviral Therapy (CHART) Study. J Card Fail 2018; 24:255-265. [PMID: 29482027 PMCID: PMC5880702 DOI: 10.1016/j.cardfail.2018.02.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 02/06/2018] [Accepted: 02/13/2018] [Indexed: 12/28/2022]
Abstract
Antiretroviral therapy (ART) has been associated with a shift in the epidemiology of human immunodeficiency virus (HIV)-associated cardiomyopathy from a phenotype of primarily left ventricular (LV) systolic dysfunction to LV diastolic dysfunction (DD). Patients with HIV receiving ART have higher rates of DD compared with age-matched control subjects and develop DD at a younger age. However, little is known about the natural history and pathogenesis of DD in virally suppressed HIV-infected patients. Current evidence suggests that immune processes modulate the risk for cardiac involvement in HIV-infected persons. Ongoing inflammation appears to have myocardial effects, and accelerated myocardial fibrosis appears to be a key mediator of HIV-induced DD. The Characterizing Heart Function on Antiretroviral Therapy (CHART) study aims to systematically investigate determinants, mechanisms, and consequences of DD in HIV-infected patients. We will compare ART-treated virally suppressed HIV-infected individuals with and without DD and HIV- individuals with DD regarding (1) systemic inflammation, myocardial stress, and subclinical myocardial necrosis as indicated by circulating biomarkers; (2) immune system activation as indicated by cell surface receptors; (3) myocardial fibrosis according to cardiac magnetic resonance examination; (4) markers of fibrosis and remodeling, oxidative stress, and hypercoagulability; (5) left atrial function according to echocardiographic examination; (6) myocardial stress and subclinical necrosis as indicated by circulating biomarkers; (7) proteomic and metabolic profiles; and (8) phenotype signatures derived from clinical, biomarker, and imaging data.
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Affiliation(s)
- Javed Butler
- Cardiology Division, Department of Medicine, Stony Brook University, Stony Brook, New York.
| | | | - Kevin J Anstrom
- Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Priscilla Y Hsue
- Cardiology Division, Department of Medicine, University of California, San Francisco, California
| | - Raymond J Kim
- Cardiology Division, Department of Medicine, Duke University, Durham, North Carolina
| | - Rebecca Scherzer
- UCSF Department of Medicine and San Francisco Department of Veterans Administration, San Francisco, California
| | - Sanjiv J Shah
- Cardiology Division, Department of Medicine, Northwestern Feinberg School of Medicine, Chicago, Illinois
| | - Svati H Shah
- Cardiology Division, Department of Medicine, Duke University, Durham, North Carolina
| | - Eric J Velazquez
- Duke Clinical Research Institute, Duke University, Durham, North Carolina; Cardiology Division, Department of Medicine, Duke University, Durham, North Carolina
| | - Adrian F Hernandez
- Cardiology Division, Department of Medicine, Duke University, Durham, North Carolina
| | - Patrice Desvigne-Nickens
- Division of Cardiovascular Sciences, National, Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Eugene Braunwald
- Cardiology Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Abstract
PURPOSE OF REVIEW In this paper we will review the modern diagnostic approach to patients with clinically suspected myocarditis as well as the treatment modalities and strategy in light of up-to-date clinical experience and scientific evidence. RECENT FINDINGS Rapidly expanding evidence suggests that myocardial inflammation is frequently underdiagnosed or overlooked in clinical practice, although new therapeutic options have been validated. Moreover, the available evidence suggests that subclinical cardiac involvement has negative prognostic impact on morbidity and mortality and should be actively investigated and adequately treated. Myocarditis represents a growing challenge for physicians, due to increased referral of patients for endomyocardial biopsy (EMB) or cardiac magnetic resonance (CMR), and requires a highly integrated management by a team of caring physicians.
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Karim B, Wijaya IP, Rahmaniyah R, Ariyanto I, Waters S, Estiasari R, Price P. Factors affecting affect cardiovascular health in Indonesian HIV patients beginning ART. AIDS Res Ther 2017; 14:52. [PMID: 28859681 PMCID: PMC5580224 DOI: 10.1186/s12981-017-0180-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Accepted: 08/23/2017] [Indexed: 01/20/2023] Open
Abstract
Background We present a small longitudinal study of how demographic factors and persistent burdens of HIV and cytomegalovirus (CMV) influence cardiovascular health in young adults beginning ART in an inner-city clinic in Jakarta, Indonesia. Methods ART-naïve HIV patients [n = 67; aged 31 (19 to 48) years] were enrolled in the JakCCANDO Project. Echocardiography and carotid Doppler ultrasonography were performed before ART (V0) and after 3, 6, and 12 months (V3–12). Antibodies reactive with CMV lysate or IE-1 protein were assessed at each timepoint and CMV DNA was identified at V0. Results Markers of adverse cardiovascular prognosis [left ventricular mass index, ejection fraction and carotid intimal media thickness (cIMT)] were similar to healthy controls, but increased at V12. Internal diameters of the carotid arteries and systolic blood pressure correlated with HIV disease severity at V0, but cardiac parameters and cIMT did not. E/A ratios (left ventricular diastolic function) were lower in patients with CMV DNA at V0, but this effect waned by V6. Levels of antibody reactive with CMV IE-1 correlated inversely with CD4 T cell counts at V0, and levels at V6–V12 correlated directly with the right cIMT. Conclusions Overall the severity of HIV disease and the response to ART have only subtle effects on cardiovascular health in this young Asian population. CMV replication before ART may have a transient effect on cardiac health, whilst antibody reactive with CMV IE-1 may mark a high persistent CMV burden with cumulative effects on the carotid artery.
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Mietsch M, Sauermann U, Mätz-Rensing K, Klippert A, Daskalaki M, Stolte-Leeb N, Stahl-Hennig C. Revisiting a quarter of a century of simian immunodeficiency virus (SIV)-associated cardiovascular diseases at the German Primate Center. Primate Biol 2017; 4:107-115. [PMID: 32110698 PMCID: PMC7041533 DOI: 10.5194/pb-4-107-2017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 05/04/2017] [Indexed: 01/08/2023] Open
Abstract
Human immunodeficiency virus (HIV) comorbidities have become
clinically more important due to antiretroviral therapy. Although therapy
increases life expectancy, it does not completely suppress immune activation
and its associated complications. The simian immunodeficiency virus
(SIV)-infected rhesus macaque (Macaca mulatta) represents a valuable
model for the investigation of SIV-associated diseases. Although
cardiovascular (CV) changes are common in HIV-infected patients, there are
only a few reports on the incidence of CV findings in SIV-infected animals.
In addition, potential associations between pathohistological findings and
hematological parameters are still unclear. We therefore conducted a retrospective analysis of 195 SIV-infected rhesus
macaques that were euthanized with AIDS-related symptoms at the German
Primate Center, Goettingen, over a 25-year period. Pathological findings
were correlated with hematological data. The main findings included myocarditis (12.8 %), endocarditis
(9.7 %),
and arteriopathy (10.3 %) in various organs. Thrombocytopenia occurred
more frequently in macaques with endocarditis or arteriopathy than in
macaques without CV disease (80 % in animals with endocarditis, 60 %
in animals with arteriopathy, p<0.0001 and p=0.0016, respectively). Further investigations of the interaction between coagulation markers,
proinflammatory cytokines, and biomarkers associated with endothelial
dysfunction (e.g., D-dimers) and histological data (vascular wall structure)
may unravel the mechanisms underlying HIV/SIV-associated CV comorbidities.
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Affiliation(s)
- Matthias Mietsch
- Unit of Infection Models, German Primate Center, 37077 Goettingen, Germany.,These authors contributed equally to this work
| | - Ulrike Sauermann
- Unit of Infection Models, German Primate Center, 37077 Goettingen, Germany.,These authors contributed equally to this work
| | | | - Antonina Klippert
- Unit of Infection Models, German Primate Center, 37077 Goettingen, Germany
| | - Maria Daskalaki
- Unit of Infection Models, German Primate Center, 37077 Goettingen, Germany
| | - Nicole Stolte-Leeb
- Unit of Infection Models, German Primate Center, 37077 Goettingen, Germany
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Abstract
Over the last 2 decades human immunodeficiency virus (HIV) infection has become a chronic disease requiring long-term management. Aging, antiretroviral therapy, chronic inflammation, and several other factors contribute to the increased risk of cardiovascular disease in patients infected with HIV. In low-income and middle-income countries where antiretroviral therapy access is limited, cardiac disease is most commonly related to opportunistic infections and end-stage manifestations of HIV/acquired immunodeficiency syndrome, including HIV-associated cardiomyopathy, pericarditis, and pulmonary arterial hypertension. Cardiovascular screening, prevention, and risk factor management are important factors in the management of patients infected with HIV worldwide.
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Affiliation(s)
- Gerald S Bloomfield
- Division of Cardiology, Duke Global Health Institute, Duke Clinical Research Institute, Duke University, 2400 Pratt Street, Durham, NC 27705, USA.
| | - Claudia Leung
- Feinberg School of Medicine, Northwestern University, 420 East Superior Street, Chicago, IL 60611, USA
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43
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Barasa FA, Vedanthan R, Pastakia SD, Crowe SJ, Aruasa W, Sugut WK, White R, Ogola ES, Bloomfield GS, Velazquez EJ. Approaches to Sustainable Capacity Building for Cardiovascular Disease Care in Kenya. Cardiol Clin 2016; 35:145-152. [PMID: 27886785 DOI: 10.1016/j.ccl.2016.08.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Cardiovascular diseases are approaching epidemic levels in Kenya and other low- and middle-income countries without accompanying effective preventive and therapeutic strategies. This is happening in the background of residual and emerging infections and other diseases of poverty, and increasing physical injuries from traffic accidents and noncommunicable diseases. Investments to create a skilled workforce and health care infrastructure are needed. Improving diagnostic capacity, access to high-quality medications, health care, appropriate legislation, and proper coordination are key components to ensuring the reversal of the epidemic and a healthy citizenry. Strong partnerships with the developed countries also crucial.
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Affiliation(s)
| | - Rajesh Vedanthan
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Susie J Crowe
- Purdue University College of Pharmacy, West Lafayette, IN, USA
| | | | | | - Russ White
- Tenwek Mission Hospital, Bomet, Kenya; Alpert School of Medicine, Brown University, 2 Dudley Street, PO Box 39, Providence, RI 02905, USA
| | - Elijah S Ogola
- Department of Clinical Medicine, College of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - Gerald S Bloomfield
- Department of Medicine, Duke Clinical Research Institute, Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Eric J Velazquez
- Department of Medicine, Duke Clinical Research Institute, Duke Global Health Institute, Duke University, Durham, NC, USA
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Dos Santos Ferreira R, de Cássia Avellaneda Guimarães R, Jardim Cury Pontes ER, Aragão do Nascimento V, Aiko Hiane P. The Effectiveness of a Bioactive Food Compound in the Lipid Control of Individuals with HIV/AIDS. Nutrients 2016; 8:nu8100598. [PMID: 27740592 PMCID: PMC5083986 DOI: 10.3390/nu8100598] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 09/09/2016] [Accepted: 09/19/2016] [Indexed: 01/12/2023] Open
Abstract
Cardiovascular events due to decompensated lipid metabolism are commonly found in Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) patients using anti-retroviral therapy (HAART). Thus, the aim of this study was to identify the effect of a bioactive food compound (BFC) containing functional foods on individuals with HIV undergoing HAART. Particularly, this study aims to verify the clinical outcome in the change of the lipid profile due to the use of this compound. This study includes 115 individuals with HIV on HAART. All patients received dietary guidelines; however, sixty-one consumed BFC while fifty-one did not (NO BFC). Biochemical examinations and socio-demographic and clinical profiles were evaluated. As result, in patients using hypolipidemic and/or hypoglycemic drugs, there was 28.6% decrease in triglyceride levels (p < 0.001) in the NO BFC group, and 18.3% reduction in low density lipoprotein cholesterol (LDL-C) (p < 0.001) in the BFC group. In patients who did not use hypolipidemic and/or hypoglycemic drugs in the NO BFC group, there was 30.6% increase in triglycerides, 11.3% total cholesterol and 15.3% LDL-C levels (p < 0.001) while for the BFC group there was 4.5% reduction in total cholesterol (p < 0.001). In conclusion, this study evidenced that the dietary intervention containing BFC positively affected in lipid control, since these HIV/AIDS patients using HAART are more vulnerable to lipid disorders.
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Affiliation(s)
- Rosângela Dos Santos Ferreira
- Nutrition Service, University Hospital, Federal University of Mato Grosso do Sul-UFMS, Campo Grande 79079-900, MS, Brazil.
| | - Rita de Cássia Avellaneda Guimarães
- Post Graduate Program in Health and Development in the Central-West Region of Brazil, Federal University of Mato Grosso do Sul-UFMS, Campo Grande 79079-900, MS, Brazil.
| | - Elenir Rose Jardim Cury Pontes
- Post Graduate Program in Health and Development in the Central-West Region of Brazil, Federal University of Mato Grosso do Sul-UFMS, Campo Grande 79079-900, MS, Brazil.
| | - Valter Aragão do Nascimento
- Post Graduate Program in Health and Development in the Central-West Region of Brazil, Federal University of Mato Grosso do Sul-UFMS, Campo Grande 79079-900, MS, Brazil.
| | - Priscila Aiko Hiane
- Post Graduate Program in Health and Development in the Central-West Region of Brazil, Federal University of Mato Grosso do Sul-UFMS, Campo Grande 79079-900, MS, Brazil.
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Abstract
PURPOSE OF REVIEW The article traces the pathways leading from viral infection of the heart by coxsackievirus B3 to autoimmune myocarditis in its various manifestations. RECENT FINDINGS Myocarditis can be induced by a number of different infectious agents and represents a significant cause of death especially in young individuals. Following infection, patients may develop lymphocytic, eosinophilic, or giant cell/granulomatous myocardial inflammation. It can lead to infectious dilated cardiomyopathy, a disease frequently requiring cardiac transplantation. Although acute viral myocarditis is frequently subclinical and recovery may be spontaneous, treatment of chronic myocarditis is currently unsatisfactory. Ongoing disease may be because of persistent virus in the heart or to immunopathic attack. Depending on the cause, treatment may be antiviral or immunosuppressive. Endomyocardial biopsy is proving of value in determining cause and deciding future therapy. A great deal of information about the pathogenesis of myocarditis has been gained from experimental models in rodents using heart disease induced by infection using coxsackievirus B3 or by immunization with cardiac myosin. SUMMARY Treatment of myocarditis is still problematic and may depend on etiologic diagnosis to distinguish infectious from immune-mediated disease. Both pathogenic mechanisms may co-occur in individual patients. In the future, treatment may depend upon endomyocardial biopsy, immunohistologic testing, improved imaging, and molecular genetic analysis for providing more precise diagnoses.
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Affiliation(s)
- Noel R Rose
- Department of Pathology, Brigham and Women's Hospital Harvard Medical School, Boston, USA
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