Key result
Stopping antiretroviral therapy and starting HF medications improves LVEF by ~10 points in HIV cardiomyopathy.
Why the study?
HIV-associated cardiomyopathy is an uncommon but important cause of heart failure in young people and is frequently late recognised, with difficulty distinguishing HIV-related myocardial injury from antiretroviral cardiotoxicity.
Case Report (n=1)
This case illustrates the difficulty of differentiating HIV-related myocardial injury from antiretroviral cardiotoxicity and highlights the practical limitations of implementing guideline-directed heart failure therapy in hypotensive patients.
Should not yet change ART or HF management; leaves open need for controlled studies in HIV cardiomyopathy.
RetaCardiomyopathy related to human immunodeficiency virus (HIV) infection is an uncommon but important cause of heart failure in young people and is frequently late recognised . We report the case of a young woman with HIV infection diagnosed in 2021 and treated with combination antiretroviral therapy, who presented with progressive breathlessness, tachycardia and hypotension. Echocardiography showed a dilated, globally hypokinetic left ventricle with severely reduced ejection fraction. Her condition deteriorated over the following weeks, and a multidisciplinary decision was taken to interrupt antiretroviral therapy while heart failure treatment was intensified. Persistent hypotension prevented the introduction of an angiotensin receptor-neprilysin inhibitor and a beta-blocker, and treatment was limited to ivabradine, torsemide, a mineralocorticoid receptor antagonist and empagliflozin. Partial improvement in left ventricular systolic function and reverse remodelling followed. This case illustrates the difficulty of separating HIV-related myocardial injury from antiretroviral cardiotoxicity, and the practical limits of guideline-directed therapy in the hypotensive patient.
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Raimjanov et al. (2026) conducted a case report in HIV-associated dilated cardiomyopathy (n=1). Antiretroviral therapy interruption and partial heart failure therapy vs. Baseline (before intervention) was evaluated on Left ventricular ejection fraction. Interruption of antiretroviral therapy and partial heart failure treatment improved left ventricular ejection fraction from 23% to 33% and reduced NT-proBNP in a young woman with HIV cardiomyopathy.
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