Johns Hopkins Medical Institutions, Division of Cardiology.
MedStar Heart and Vascular Institute, Baltimore, Maryland.
Curr Opin HIV AIDS. 2022 Sep 1;17(5):261-269. doi: 10.1097/COH.0000000000000753. Epub 2022 Jul 16.
To summarize the state-of-the-art literature on the epidemiology, disease progression, and mediators of heart failure, tachyarrhythmias, and sudden cardiac death in people living with HIV (PLWH) to inform prevention strategies.
Recent studies corroborate the role of HIV as a risk enhancer for heart failure and arrhythmias, which persists despite adjustment for cardiovascular risk factors and unhealthy behaviors. Immune activation and inflammation contribute to the risk. Heart failure occurs more frequently at younger ages, and among women and ethnic minorities living with HIV, highlighting disparities. Prospective outcome studies remain sparse in PLWH limiting prevention approaches. However, subclinical cardiac and electrophysiologic remodeling and dysfunction detected by noninvasive testing are powerful disease surrogates that inform our mechanistic understanding of HIV-associated cardiovascular disease and offer opportunities for early diagnosis.
Aggressive control of HIV viremia and cardiac risk factors and abstinence from unhealthy behaviors remain treatment pillars to prevent heart failure and arrhythmic complications. The excess risk among PLWH warrants heightened vigilance for heart failure and arrhythmic symptomatology and earlier testing as subclinical abnormalities are common. Future research needs include identifying novel therapeutic targets to prevent heart failure and arrhythmias and testing of interventions in diverse groups of PLWH.
总结有关艾滋病毒感染者（PLWH）心力衰竭、心动过速和心源性猝死的流行病学、疾病进展和介质的最新文献，为预防策略提供信息。
最近的研究证实了 HIV 作为心力衰竭和心律失常的风险增强因素的作用，尽管对心血管危险因素和不健康行为进行了调整，但这种作用仍然存在。免疫激活和炎症促成了这种风险。心力衰竭更常发生在年龄较小的人群中，在 HIV 感染者中的女性和少数民族中更为常见，突出了差异。前瞻性结局研究在 PLWH 中仍然很少，限制了预防方法。然而，非侵入性检测检测到的亚临床心脏和电生理重塑和功能障碍是强有力的疾病替代物，为我们对 HIV 相关心血管疾病的机制理解提供了信息，并为早期诊断提供了机会。
积极控制 HIV 病毒血症和心脏危险因素，戒除不健康的行为仍然是预防心力衰竭和心律失常并发症的治疗支柱。PLWH 中的这种额外风险需要高度警惕心力衰竭和心律失常的症状，并更早进行检测，因为亚临床异常很常见。未来的研究需要包括确定预防心力衰竭和心律失常的新治疗靶点，并在不同的 PLWH 群体中测试干预措施。
