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Coronary artery disease in patients with human immunodeficiency virus infection

  • REVIEW ARTICLE
  • Published:
Journal of Nuclear Cardiology Aims and scope

Abstract

The life expectancy of people infected with human immunodeficiency virus (HIV) is rising due to better access to combination anti-retroviral therapy (ART). Although ART has reduced acquired immune deficiency syndrome (AIDS) related mortality and morbidity, there has been an increase in non-AIDS defining illnesses such as diabetes mellitus, hypercholesterolemia and coronary artery disease (CAD). HIV is a disease marked by inflammation which has been associated with specific biological vascular processes increasing the risk of premature atherosclerosis. The combination of pre-existing risk factors, atherosclerosis, ART, opportunistic infections and coagulopathy contributes to rising CAD incidence. The prevalence of CAD has emerged as a major contributor of morbidity in these patients due to longer life expectancy. However, ART has been associated with lipodystrophy, dyslipidemia, insulin resistance, diabetes mellitus and CAD. These adverse effects, along with drug–drug interactions when ART is combined with cardiovascular drugs, result in significant challenges in the care of this group of patients. Exercise tolerance testing, echocardiography, myocardial perfusion imaging, coronary computed tomography angiography and magnetic resonance imaging help in the diagnosis of CAD and heart failure and help predict cardiovascular outcomes in a manner similar to non-infected individuals. This review will highlight the pathogenesis and factors that link HIV to CAD, presentation and treatment of HIV-patients presenting with CAD and review briefly the cardiac imaging modalities used to identify this entity and help prognosticate future outcomes.

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Abbreviations

ACS:

Acute coronary syndrome

AIDS:

Acquired immune deficiency syndrome

ART:

Anti-retroviral therapy

CABG:

Coronary artery bypass grafting

CAC:

Coronary artery calcium

CAD:

Coronary artery disease

CCTA:

Coronary computed tomography angiography

CD:

Clusters of differentiation

CFR:

Coronary flow reserve

CT:

Computed tomography

CVD:

Cardiovascular disease

FDG:

Fluorodeoxyglucose

GLUT4:

Glucose transporter 4

HDL:

High-density lipoprotein

HIV:

Human immunodeficiency virus

IFN:

Interferon

IL-6:

Interleukin-6

LDL:

Low-density lipoprotein

LV:

Left ventricular

MACS:

Multicenter AIDS cohort study

MBF:

Myocardial blood flow

MCP-1:

Monocyte chemotactic protein-1

MI:

Myocardial infarction

MPI:

Myocardial perfusion imaging

MRI:

Magnetic resonance imaging

Nef:

Negative regulatory factor

NET:

Neutrophil extracellular traps

NNRTI:

Non-nucleoside reverse transcriptase inhibitor

NRTI:

Nucleoside reverse transcriptase inhibitor

PET:

Positron emission tomography

PI:

Protease inhibitor

PLWH:

People living with human immunodeficiency virus

SE:

Stress echocardiography

SMART:

Strategies for management of antiretroviral therapy

SPECT:

Single photon emission computed tomography

STEMI:

ST-segment elevation myocardial infarction

Tat:

Trans-activator of transcription

Tl-201:

Thallium-201

TIMI:

Thrombolysis in myocardial infarction

TLR:

Toll-like receptor

TNF:

Tumor necrosis factor

UNAIDS:

United Nations programme on human immunodeficiency virus/acquired immune deficiency syndrome

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Authors and Affiliations

  1. Department of Cardiology and Nuclear Cardiovascular Imaging Laboratory, New York Medical College, Westchester Medical Center, 100 Woods Road, Valhalla, NY, 10595, USA

    Pratik Mondal MBBS & Diwakar Jain MD, FACC, FRCP, FSNMMI, MASNC

  2. King Abdulaziz Cardiac Center, Ministry of National Guard-Health Affaire, Riyadh, Saudi Arabia

    Ahmed Aljizeeri MBChB, FASNC

  3. King Abdullah International Medical Research Center, Riyadh, Saudi Arabia

    Ahmed Aljizeeri MBChB, FASNC

  4. King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia

    Ahmed Aljizeeri MBChB, FASNC

  5. Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada

    Gary Small MBChB, PhD, MRCP

  6. Division of Cardiology, Cook County Health, Chicago, IL, USA

    Saurabh Malhotra MD, MPH, FACC

  7. Division of Cardiology, Rush Medical College, Chicago, IL, USA

    Saurabh Malhotra MD, MPH, FACC

  8. Division of Cardiology, Augusta University Medical Center, Augusta, GA, USA

    Prakash Harikrishnan MD, FACC

  9. School of Public Health, Curtin University, Perth, Australia

    Jacquita S. Affandi PhD

  10. Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland

    Ronny R. Buechel MD

  11. Fiona Stanley Hospital, Murdoch, WA, Australia

    Girish Dwivedi MD, PhD

  12. Harry Perkins Institute of Medical Research, Murdoch, WA, Australia

    Girish Dwivedi MD, PhD

  13. The University of Western Australia, Crawley, WA, Australia

    Girish Dwivedi MD, PhD

  14. Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA

    Mouaz H. Al-Mallah MBChB, FASNC

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  1. Pratik Mondal MBBS
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Mondal, P., Aljizeeri, A., Small, G. et al. Coronary artery disease in patients with human immunodeficiency virus infection. J. Nucl. Cardiol. 28, 510–530 (2021). https://doi.org/10.1007/s12350-020-02280-4

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