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Etiology and pathophysiology of heart failure in people with HIV

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Abstract

HIV-associated cardiomyopathy is a well-established sequela in people infected with HIV (PHIV). Despite significant advances in HIV management through the use of highly active anti-retroviral therapy (HAART), PHIV on HAART continue to have elevated risk of cardiomyopathy and heart failure, even when accounting for known cardiovascular risk factors. This review article will explore the proposed mechanisms by which chronic HIV infection induces cardiomyopathy and heart failure in the setting of HAART. Evaluation, work-up, and management of cardiomyopathy in PHIV will also be briefly discussed. The advent of HAART has altered the pathophysiology HIV-associated cardiomyopathy from a rapidly progressive cardiomyopathy, often with pericardial involvement, into a chronic process involving inflammation and persistent immune dysregulation. With the significant decrease in AIDS-related deaths, the prevalence of cardiomyopathy and the mortality associated with heart failure in PHIV have increased. Multiple immune-related and inflammatory mechanisms have been proposed, which may provide insight into evaluation and management of cardiomyopathy in PHIV.

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Role of the funder: The funding source had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

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Authors and Affiliations

  1. Section of Inflammation and Cardiometabolic Diseases, National Institute of Health, Bethesda, MD, USA

    Harry Choi & Amit K. Dey

  2. Division of Medicine, University of South Alabama, Mobile, AL, USA

    Gaurav Sharma

  3. Division of Medicine, MedStar Union Memorial Hospital and Good Samaritan Hospital, Baltimore, MD, USA

    Rahul Bhoite

  4. Division of Infectious Diseases, University of Alabama, Birmingham, AL, USA

    Greer Burkholder

  5. Section of Cardiology, Baylor College of Medicine and the Michael E. DeBakey VA Hospital, Houston, TX, 77030, USA

    Savitri Fedson & Hani Jneid

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  1. Harry Choi
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Choi, H., Dey, A.K., Sharma, G. et al. Etiology and pathophysiology of heart failure in people with HIV. Heart Fail Rev 26, 497–505 (2021). https://doi.org/10.1007/s10741-020-10048-8

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