Cardiovascular manifestations of HIV infection

Ho, Jennifer E.; Hsue, Priscilla Y.

doi:10.1136/hrt.2008.161463

Cited by 97 publications

(108 citation statements)

References 19 publications

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“…We propose that cardiac steatosis, secondary to cART, and myocardial fibrosis may underlie the dysfunction observed. It is conceivable that in addition to the known increased incidence of HIV-related coronary disease, 5 cardiac steatosis and fibrosis may partially underlie the increased cardiac morbidity and mortality seen in this group.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, myocardial disease was reported widely in the pre-cART era, in which a high incidence of cardiomyopathy with cardiac systolic and diastolic dysfunction was found, but comprehensive analysis of a contemporary cohort of patients receiving effective therapy is lacking. 5 Recent echocardiographic studies have reported a low prevalence of HIV-related myocardial disease in settings with unrestricted access to cART or a low incidence of tuberculosis; however, isolated ventricular dilatation, systolic dysfunction without dilatation, and diastolic dysfunction have been described by use of echocardiography. 6,7 The pathogenesis of myocardial disease in HIV infection remains ill-defined but is likely to be multifactorial: myocarditis from infectious and noninfectious causes; the direct effects of HIV infection, including increased circulating proinflammatory cytokines; and complications of cART, such as abnormal fat metabolism.…”

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confidence: 99%

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Comprehensive Cardiac Magnetic Resonance Imaging and Spectroscopy Reveal a High Burden of Myocardial Disease in HIV Patients

et al. 2013

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Background— HIV infection continues to be endemic worldwide. Although treatments are successful, it remains controversial whether patients receiving optimal therapy have structural, functional, or biochemical cardiac abnormalities that may underlie their increased cardiac morbidity and mortality. The purpose of this study was to characterize myocardial abnormalities in a contemporary group of HIV-infected individuals undergoing combination antiretroviral therapy. Methods and Results— Volunteers with HIV who were undergoing combination antiretroviral therapy and age-matched control subjects without a history of cardiovascular disease underwent cardiac magnetic resonance imaging and spectroscopy for the determination of cardiac function, myocardial fibrosis, and myocardial lipid content. A total of 129 participants were included in this analysis. Compared with age-matched control subjects (n=39; 30.23%), HIV-infected subjects undergoing combination antiretroviral therapy (n=90; 69.77%) had 47% higher median myocardial lipid levels ( P <0.003) and 74% higher median plasma triglyceride levels (both P <0.001). Myocardial fibrosis, predominantly in the basal inferolateral wall of the left ventricle, was observed in 76% of HIV-infected subjects compared with 13% of control subjects ( P <0.001). Peak myocardial systolic and diastolic longitudinal strain were also lower in HIV-infected individuals than in control subjects and remained statistically significant after adjustment for available confounders. Conclusions— Comprehensive cardiac imaging revealed cardiac steatosis, alterations in cardiac function, and a high prevalence of myocardial fibrosis in a contemporary group of asymptomatic HIV-infected subjects undergoing combination antiretroviral therapy. Cardiac steatosis and fibrosis may underlie cardiac dysfunction and increased cardiovascular morbidity and mortality in subjects with HIV.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Comprehensive Cardiac Magnetic Resonance Imaging and Spectroscopy Reveal a High Burden of Myocardial Disease in HIV Patients

et al. 2013

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“…Influenza vaccination has been shown to be beneficial in reducing major cardiovascular events amongst acute coronary syndrome patients (Phrommintikul et al 2011). Furthermore, many other disparate acute and chronic pathogens, such as Clostridium pneumoniae (Vainas et al 2009), HIV (Ho and Hsue 2009), CMV (Simanek et al 2011) and gum disease-causing bacteria (Kebschull et al 2010), carry an elevated risk of CVD, suggesting that, rather than the nature of the infectious agent, it is the ensuing host-derived inflammatory response that drives this increased CVD risk. Thus, influenza infection may accelerate atherogenesis, resulting in death months after infection.…”

Section: Seasonal Influenzamentioning

confidence: 99%

The role of the T cell in age-related inflammation

Macaulay

Akbar

Henson

2012

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105

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Ageing is accompanied by alterations to T-cell immunity and also by a low-grade chronic inflammatory state termed inflammaging. The significance of these phenomena is highlighted by their being predictors of earlier mortality. We have recently published that the proinflammatory cytokine TNFα is a strong inducer of CD4 + T-cell senescence and T-cell differentiation, adding to the growing body of literature implicating proinflammatory molecules in mediating these critical age-related T-cell alterations. Moreover, the inflammatory process is also being increasingly implicated in the pathogenesis of many common and severe age-related diseases, including cancer, cardiovascular diseases and type 2 diabetes. Furthermore, major age-related risk factors for poor health, such as obesity, stress and smoking, are also associated with an upregulation in systemic inflammatory markers. We propose the idea that the ensuing inflammatory response to influenza infection propagates cardiovascular diseases and constitutes a major cause of influenzarelated mortality. While inflammation is not a negative phenomenon per se, this age-related dysregulation of inflammatory responses may play crucial roles driving age-related pathologies, T-cell immunosenescence and CMV reactivation, thereby underpinning key features of the ageing process.

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“…[3][4][5] Among the traditional cardiovascular risk factors, arterial hypertension in HIV þ patients has a prevalence similar or slightly higher than in the general population. 6,7 Beside its role as a powerful risk factor in itself, hypertension entails left ventricular (LV) changes, mainly characterized by myocardial hypertrophy and diastolic dysfunction, that are per se independent predictors of cardiovascular events.…”

Section: Introductionmentioning

confidence: 99%

Left ventricular remodelling in asymptomatic HIV infection on chronic HAART: comparison between hypertensive and normotensive subjects with and without HIV infection

et al. 2011

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The high cardiovascular risk of HIV infected (HIV þ ) patients is still partly unexplained. We aimed to evaluate if HIV infection and highly active antiretroviral therapy (HAART) are linked per se to left ventricular (LV) remodelling, independently of blood pressure (BP) values. We enrolled 4 groups of patients matched by gender, age, body mass index and smoking habit: 30 HIV þ hypertensives, 30 HIV þ normotensives, 30 notinfected (HIVÀ) hypertensives and 30 HIVÀ normotensives. HIV þ patients were on chronic HAART. Hypertension was newly diagnosed (p6 months) and never treated. Each patient underwent blood tests, 24-h BP monitoring and LV echocardiogram. The 4 groups had similar fasting glucose and cholesterol; triglycerides, HOMA index and prevalence of metabolic syndrome were higher in the HIV þ groups. Despite similar 24-h BP values, HIV þ hypertensives had greater LV mass and higher prevalence of preclinical diastolic dysfunction than HIVÀ hypertensives. Compared to HIVÀ normotensives, HIV þ normotensives had similar 24-h BP values, but greater LV mass and lower LV diastolic indices, similar to HIVÀ hypertensives, whose 24-h BP values were higher. Asymptomatic HIV infection and chronic HAART are associated with myocardial hypertrophy and preclinical diastolic dysfunction, independently of BP values.

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Cardiovascular manifestations of HIV infection

Cited by 97 publications

References 19 publications

Comprehensive Cardiac Magnetic Resonance Imaging and Spectroscopy Reveal a High Burden of Myocardial Disease in HIV Patients

Comprehensive Cardiac Magnetic Resonance Imaging and Spectroscopy Reveal a High Burden of Myocardial Disease in HIV Patients

The role of the T cell in age-related inflammation

Left ventricular remodelling in asymptomatic HIV infection on chronic HAART: comparison between hypertensive and normotensive subjects with and without HIV infection

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