aDivision of Cardiology, UCSF at Zuckerberg San Francisco General Hospital bDepartment of Medicine, University of California, San Francisco, California, USA.
Curr Opin HIV AIDS. 2017 Nov;12(6):534-539. doi: 10.1097/COH.0000000000000409.
To discuss presentation, pathophysiology, complications, and treatment of heart failure in persons living with HIV (PLWHIV) in the antiretroviral therapy (ART) era.
Since the advent of effective ART and improved longevity, heart failure has become more chronic and insidious and is often characterized by preserved ejection fraction, diastolic dysfunction, and left ventricular (LV) hypertrophy. The mechanism underlying heart failure in the setting of HIV infection remains unknown. A high burden of coronary risk factors is often present in PLWHIV, and clinical manifestations of coronary disease appear at a younger age compared with uninfected persons. Heart failure is more common in the year following myocardial infarction in HIV-infected compared with uninfected patients. Epidemiological data suggest the incidence of atrial fibrillation in PLWHIV is increasing, likely due to advancing age and increasing rates of LV hypertrophy in this population. The treatment of heart failure in PLWHIV is extrapolated from treatment of uninfected patients, as clinical trials have not been done specifically in HIV.
Symptoms of heart failure or echocardiographic evidence of cardiomyopathy increase the risk of death in PLWHIV. Additional studies are needed to ascertain if HIV-specific issues such as newer ART, chronic inflammation/immune activation, illicit drug use, and early initiation of ART are implicated in heart failure pathogenesis.
讨论在抗逆转录病毒治疗（ART）时代，艾滋病毒感染者（PLWHIV）心力衰竭的表现、病理生理学、并发症和治疗。
自有效 ART 的出现和寿命的延长以来，心力衰竭变得更加慢性和隐匿，通常表现为射血分数保留、舒张功能障碍和左心室（LV）肥厚。HIV 感染背景下心力衰竭的发生机制尚不清楚。PLWHIV 通常存在大量的冠心病危险因素，与未感染者相比，冠心病的临床表现出现在更年轻的年龄。与未感染者相比，HIV 感染者在心肌梗死后的一年内心力衰竭更为常见。流行病学数据表明，PLWHIV 中房颤的发病率正在增加，可能是由于该人群年龄的增长和 LV 肥厚的发生率增加所致。由于尚未专门针对 HIV 进行临床试验，因此 PLWHIV 心力衰竭的治疗是从未感染者的治疗中推断出来的。
心力衰竭的症状或超声心动图检查提示心肌病变的证据会增加 PLWHIV 死亡的风险。需要进一步的研究来确定是否有 HIV 特异性问题，如新型抗逆转录病毒药物、慢性炎症/免疫激活、非法药物使用和早期开始抗逆转录病毒治疗，与心力衰竭的发病机制有关。
