aUniversity Hospitals Cleveland Medical Center, Harrington Heart and Vascular Institute bCase Western Reserve University School of Medicine, Cleveland, Ohio, USA.
Curr Opin HIV AIDS. 2017 Nov;12(6):572-578. doi: 10.1097/COH.0000000000000414.
The review aims to summarize the literature describing the clinical impact of cardiac fat depots in patients with HIV infection.
People living with HIV (PLHIV) have accelerated rates of cardiovascular disease, and are prone to the development of ectopic fat deposition. Specifically, PLHIV have higher volumes of epicardial and intracardiac fat quantified by noninvasive imaging. Higher volumes of epicardial fat may be related to antiretroviral therapy duration and chronic inflammation, independently of other measures of body adiposity such as BMI. They have been associated with increased coronary artery calcium, myocardial perfusion defects, death, and myocardial infarction. The association with risk may be partly mediated through direct actions of cytokines and adipokines produced by the adipose tissue. Furthermore, HIV-infected patients have increased myocardial fat deposition that is also associated with antiretroviral therapy duration, and may be responsible for myocardial systolic and diastolic dysfunction.
PLHIV have increased fat deposition surrounding and inside the heart that may serve as an important imaging marker of risk but may also directly mediate coronary artery disease and cardiac dysfunction. Although robust data of targeted therapies is lacking, some pharmacotherapies may be able to reduce cardiac fat volumes. In the meantime, as the evidence grows, physicians may consider intensifying preventive strategies and monitoring in patients with abnormal heart fat on noninvasive imaging.
本文旨在总结描述 HIV 感染患者心脏脂肪沉积的临床影响的文献。
HIV 感染者（PLHIV）的心血管疾病发病率加速，易发生异位脂肪沉积。具体而言，PLHIV 通过非侵入性成像技术检测到的心脏外膜和心内脂肪体积更高。较高的心脏外膜脂肪体积可能与抗逆转录病毒治疗时间和慢性炎症有关，与 BMI 等其他身体脂肪测量指标无关。它与冠状动脉钙增加、心肌灌注缺陷、死亡和心肌梗死有关。这种风险相关性可能部分是通过脂肪组织产生的细胞因子和脂肪因子的直接作用介导的。此外，HIV 感染患者的心肌脂肪沉积增加，这也与抗逆转录病毒治疗时间有关，可能导致心肌收缩和舒张功能障碍。
PLHIV 心脏周围和内部脂肪沉积增加，这可能是一个重要的风险影像学标志物，但也可能直接介导冠状动脉疾病和心脏功能障碍。虽然缺乏针对特定疗法的有力数据，但一些药物治疗可能能够降低心脏脂肪量。与此同时，随着证据的增加，医生可能会考虑在心脏脂肪异常的患者中加强预防策略和监测。
