Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
Clin Cardiol. 2021 Mar;44(3):316-321. doi: 10.1002/clc.23568. Epub 2021 Feb 16.
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.
与普通人群相比，HIV 感染者发生心源性猝死的风险增加；然而，导致这种风险增加的机制仍不清楚。HIV 感染者心源性猝死风险增加的机制可能是多因素的。我们查阅了文献，以阐明和总结导致 HIV 患者心源性猝死的潜在机制。有生物学依据表明，以下机制可能在不同程度上导致 HIV 患者心源性猝死风险显著增加：室性心律失常、心肌纤维化和瘢痕形成、QTc 间期延长（既直接由 HIV 对复极的影响，也由同时存在的药物/抗逆转录病毒治疗所致）、药物滥用、结构性心脏病和早发性动脉粥样硬化。进一步了解 HIV 中心源性猝死风险增加的机制可以导致确定可改变的危险因素，实施公共卫生计划，并可能修订 ICD 植入指南，最终降低 HIV 感染者心源性猝死的发生率。需要进一步的研究来评估这些机制和危险因素的相对贡献。
