Neglected Tropical Diseases and other Infectious Diseases Affecting the Heart - Chapter 12: HIV & Heart

Human immunodeficiency virus (HIV) is a neglected tropical disease (NTD) transmitted via the exchange of bodily fluids. HIV and subsequent acquired immunodeficiency syndrome (AIDS) have a substantial global impact with approximately 38 million active cases recorded in 2019. Although HIV cases predominantly occur in regions of Africa, cases are found across all continents and continue to increase in Asia, Europe, and North America. The majority of signs, symptoms, and complications contribute to HIV, and subsequently AIDS, are due to immune dysfunction. AIDS, the most complex and severe stage of HIV, is characterized by severe immunocompromise and opportunistic infections. Physiopathology of cardiovascular (CV) involvement complications of HIV typically occur in late stage disease and include coronary artery disease (CAD), heart failure, dilated cardiomyopathy, pericardial effusion, and arrythmias. The pathophysiology of these CV consequences is not fully understood. However, emerging research suggests that immune dysfunction, chronic inflammation, repercussions of antiretroviral therapy (ART), opportunistic infections, autoimmune reactions, and increased prevalence of CV risk factors may play a role. Clinical consequences are greatly dependent on time of detection, as well as access to diagnostic modalities and treatment measures. Notably, the world health organization (WHO) estimates that 19% of people living with HIV/AIDS (PLWHA) are unaware of their infection status. It is imperative that diagnostic and treatment measures are made widely available in order to prevent CV implications of HIV, reducing global morbidity and mortality.