Cardiovascular Manifestations of HIV Infection

Studies published over the past three years have tracked the incidence and course of human immunodeficiency virus (HIV) infection in relation to cardiac illness in both children and adults1 (Table 1). This recent work shows that subclinical echocardiographic abnormalities independently predict adverse outcomes and identify high-risk groups who can then be targeted for early intervention and therapy2. Table 1 HIV-associated cardiovascular abnormalities The introduction of highly active antiretroviral therapy (HAART) regimens has greatly modified the course of HIV disease, with longer survival and better quality of life; however, early data from those treated raise concerns about a possible increase in both peripheral and coronary arterial diseases. In global terms HAART is available only to a minority of HIV-infected individuals, and studies before the advent of HAART remain applicable. UNAIDS estimates that 36.1 million people were living with HIV infection at the end of the year 20003. If 9-10% of patients develop symptomatic heart failure over 2-5 years4, then 3 million cases of HIV-related heart failure will present in that time period5. In this review article, I discuss the principal HIV-associated cardiovascular manifestations, with an emphasis on new knowledge about prevalence, pathogenesis and treatment.