Introduction
Heart disease is an umbrella term that refers to different conditions affecting the structure and functioning of the heart. Several health conditions such as HIV, AIDS, high blood pressure, diabetes, high cholesterol, family history, age, and unhealthy lifestyle are some of the risk factors for heart disease. Human immunodeficiency virus (HIV), which causes acquired immunodeficiency syndrome (AIDS), is a growing problem in terms of incidence and mortality worldwide. Cardiologists are encountering this condition more frequently in their clinical practice, and hence, HIV has been a diagnostic and therapeutic challenge to many healthcare professionals. The treatment of cardiovascular diseases in patients with HIV/AIDS can vary from other patients depending on the drug interactions, the response of the patient, and various other factors. However, the severity and incidence of opportunistic infections in HIV have reduced recently due to the highly active antiretroviral therapy (HAART) and various prophylactic drugs.
What Is HIV?
The human deficiency virus is a microorganism that attacks the immune system and makes the individual susceptible to various infections or diseases. It can spread to others via body fluids, unprotected sex, or sharing needles with the infected person. HIV infections can cause complications such as neuropathy (nerve damage), nephropathy (kidney damage), hepatitis (inflammation of the liver), cardiovascular diseases, premature bone loss, dyslipidemia (imbalance of lipids), and other conditions. When left untreated, it causes the disease known as AIDS, for which there is no permanent treatment available. However, a treatment known as antiretroviral therapy (ART) is available, which reduces the HIV organisms in the blood, stops the progression of the disease, prevents transmission of the virus to others, and improves the quality of life of the patients.
What Is the Association Between HIV and Heart Disease?
HIV, hypertension (high blood pressure), obesity (overweight), smoking, lack of physical activities, and unhealthy diet are considered some of the risk factors for the development of heart diseases. Stimulation of the immune system by certain HIV medications can cause increased inflammation and irritation in the body tissues. This can lead to the development of plaque in the blood vessels of the heart and trigger various heart diseases. Studies have shown that the risk of stroke or heart attack is about 1.5 to two times higher in HIV patients despite antiretroviral therapy. It can be due to an imbalance in the CD4 and CD8 cells (white blood cells that help fight infections) during HIV infections.
Abnormal heart rhythms and heart failure are known to be more likely in HIV patients. Studies are in progress to evaluate this risk by monitoring heart function and scarring through echocardiography and magnetic resonance imaging (MRI) tests. Myocarditis (inflammation of the heart muscle) is also known to be common in HIV patients due to susceptibility to infections; however, it is difficult to identify the specific cause. Pulmonary hypertension, bacterial endocarditis, and cardiac tumors such as Kaposi sarcoma and non-Hodgkin’s lymphoma are more frequently secondary in HIV patients rather than primary as in a normal population. The incidence of deep vein thrombosis (DVT) is around ten times more common in HIV-infected patients compared to normal people.
Why Does HIV Increase the Risk of Heart Disease?
The risk factors for heart disease are the same for all individuals. However, patients with HIV are at a higher risk due to the presence of the virus and the HIV medications. Antiretroviral therapy is highly beneficial for HIV patients as it increases the lifespan and also improves the quality of life. Still, some patients experience heart disease and its complications at a faster rate compared to people without HIV infection. However, the exact reason behind this is not completely understood. Different cardiac medications, including statins prescribed for lowering cholesterol levels, may interact with certain HIV drugs, making them less efficient. This can also be a reason for the increased risk of heart disease in HIV patients.
Studies have shown that men with long-term infections are more prone to developing plaque (fatty deposits) in the coronary arteries, regardless of other factors of coronary disease and in comparison to uninfected men. Partially calcified and noncalcified plaques are more likely to trigger clot formation, which is responsible for the blockage of blood flow. This was observed to be more prevalent in men with HIV infection, suggesting a high risk for heart attacks. Research is still in progress to understand the exact reason behind this, and different therapies are being developed and tested to prevent cardiovascular diseases in the HIV population.
Another study demonstrates that individuals with HIV-infected coronary arteries but without plaque development reacted abnormally to stress, which was almost similar to patients with severe coronary disease. This shows that even before the plaque is detected in the arteries of HIV-infected patients, they exhibit abnormal responses, which can have adverse outcomes in comparison to non-infected people. This can be attributed to the elevated levels of inflammatory cells and immune activation in HIV patients. Research is ongoing to test newer medicines to treat high cholesterol levels, study the novel biomarkers of inflammation, and evaluate whether decreasing inflammation can improve heart health.
How Can the Risk of Heart Disease be Reduced in HIV Patients?
HIV patients must provide exact symptoms and history to healthcare specialists during checkups and medical examinations. Healthcare professionals must also include details such as traditional risk factors for cardiac diseases, opportunistic infections, and details of past and present antiretroviral medications. Patients who are not under antiretroviral therapy and present with cardiac symptoms must be referred immediately to an infectious disease specialist for appropriate decision-making for the management of both conditions. Cardiotoxic medications may need to be discontinued in patients with pre-existing or those who have presently developed cardiac symptoms. The adverse effects of antiretroviral drugs must be carefully considered, especially in patients with cardiovascular conditions.
Patients with HIV infection must take the prescribed medicines regularly and as exactly instructed by the doctor. A healthy diet must be consumed, including a variety of fruits and vegetables, whole grains, and foods low in sugars, salts, and saturated fats. Patients must try to be physically active and avoid smoking and alcohol consumption. Regular checkups or medical appointments must be followed, and any symptoms or changes in health condition must be immediately reported to the healthcare provider.
Conclusion
Patients with HIV and symptoms of cardiac disease represent a diagnostic and therapeutic challenge to healthcare specialists. Management of HIV patients with cardiac symptoms can significantly vary compared to non-infected people. A precise knowledge of the antiretroviral therapy and opportunistic infections affecting the heart must be considered to determine the exact diagnosis. Coordination between infectious disease specialists and cardiologists, along with patient cooperation, is highly necessary for the successful management of cardiovascular diseases in HIV patients.
