Cardiovascular Diseases and HIV - An Overview

Introduction

Human immunodeficiency virus or HIV, also known as acquired immunodeficiency syndrome (AIDS), is a growing global healthcare problem regarding its incidence and mortality. Patients with this condition live much longer if treated with HAART or highly active antiretroviral therapy. For individuals living with HIV, the incidence of having an episode of a heart attack or an episode of stroke is approximately double-time higher as against the people who do not suffer from HIV. This is the case even if the patient is under antiretroviral therapy or does not have any underlying chronic condition such as diabetes or thyroid. The core reason for this is, in patients with HIV, the virus accelerates all the age-related symptoms and weakens the heart. The heart is inflamed and thus becomes a nesting spot for multiple cardiovascular conditions.

What Are the Causes of Cardiovascular Conditions in HIV Patients?

Every year, around 2.6 million people lose their lives because of HIV-related cardiovascular disorders. The number will increase as an aging population of people with HIV develops risks for ailments and conditions other than AIDS in the coming times. Researchers initially thought the increased risk for cardiovascular disease among people with HIV was partially linked to antiretroviral therapy. This treatment uses a combination of medications to suppress HIV-related infections. But recent studies oppose the fact that people who received continuous antiretroviral therapy had lower risks of cardiovascular events than those who went on intermittent antiretroviral treatment. Instead, researchers have documented that the increased heart disease risk may be dependent on chronic inflammation and an unusual stimulation of the immune system by HIV even when the virus is well-controlled. In a chronic viral infection like HIV, it is seen that there could be some off-target effects in keeping HIV under control. Some other causes may be:

• Opportunistic infections.

• Prevention of certain conditions.

• Diabetes mellitus.

• Hypertension.

• Intravenous drug usage complication.

What Are the Different Cardiovascular Diseases That an HIV Patient May Develop?

Cardiac conditions that may occur in patients with HIV due to their susceptibility to it are mentioned below.

• Pericardial diseases include the pericardium, which is the protective sac-like structure of the heart.

• Kaposi’s sarcoma.

• Myocardial conditions include cardiomyopathy and myocarditis which basically damage the chambers of the heart.

• Cardiac tumors.

• Toxicity in the cardiovascular system due to a drug.

• Non-Hodgkin’s lymphoma.

• Primary cardiac lymphoma.

• Valvular or endocardial diseases that are secondary to marantic or bacterial infections.

• Arrhythmia-related heart disorders.

• Coronary artery disease.

• Cerebral and peripheral vascular heart conditions.

• Pulmonary hypertension.

• Venous thrombosis (formation of a blood clot within a vein).

• Aneurysmal disorders (abnormal dilation or bulging of a blood vessel).

• Atherosclerosis (progressive condition where fatty deposits (plaques) build up inside the arteries).

• Stenosis (abnormal narrowing of a blood vessel or a valve in the body).

• Regurgitation (backward flow of blood through a valve in the heart).

• Heart chambers prolapse.

• Heart failure.

• Ischemic heart disease.

What Are the Symptoms of an HIV Patient Suffering From a Cardiovascular Disease?

There are certain cases that show no symptoms at all. On the opposite side, there are patients who offer a range of mixed symptoms that make the cardiac condition diagnosis. Nevertheless, there are some symptoms that are generally present in almost all HIV patients suffering from cardiovascular disease.

• Shortness of breath.

• Fatigue.

• Weakness.

• Chest pain.

• Hypertension.

• High cholesterol levels.

• Stress.

• Obesity.

How to Diagnose a Cardiovascular Condition in a Patient Suffering From HIV?

Thorough history evaluation and physical examination are the two critical factors in diagnosing the underlying cardiovascular event within an HIV-positive patient. Professionals must also be aware of the signs and symptoms that manifest during the presence of cardiovascular disease. A crucial question to ask the patient is if they are immunodeficient or immunocompetent. The answer to this question is acquired by a CD4 (cluster of differentiation 4) count test. Below are some of the essential diagnostic tools to determine the presence of a cardiovascular condition in an HIV patient.

• Routine electrocardiography.

• Routine transthoracic echocardiography.

• Updated CD4 count result.

• Endomyocardial biopsy.

• Cardiac imaging.

• Exercise tolerance test.

• Myocardial perfusion scintigraphy.

• Positron emission tomography.

How to Treat Cardiovascular Diseases in HIV Patients?

There is no clear-cut treatment plan for a patient with HIV as well as an underlying cardiovascular condition. The initial treatment plan reduces the risk of the diagnosed cardiovascular disease. Symptomatic treatment is the following line of treatment. Since the cardiovascular condition varies in different HIV patients, the treatment also is dependent on the same and varies. An interdisciplinary approach involving a team of professionals is the key to proper treatment and management strategy to halt the cardiovascular condition or at least reduce the present clinical manifestations of the same.

How Can an HIV Patient Prevent Cardiovascular Diseases?

The healthcare provider must be exhaustively alert of the drugs that are not recommended and must never be used for patients who may show even the slightest sign of cardiovascular malfunctioning. Prevention starts by filling the healthcare provider with every minute drug detail that the patient is currently administering or has administered recently. Additional vital ways to prevent cardiac diseases that an HIV patient may choose to follow are mentioned below.

• Regular exercise.

• Controlling cholesterol levels.

• Maintaining ideal body weight.

• Keep moving throughout the day.

• Avoiding sedentary lifestyles.

• Smoking is one of the red flags to start a heart problem.

• Alcohol should be avoided.

• Following a diet plan after consulting a nutritionist.

• Involving all essential nutrients in daily meals to fight opportunistic infections.

• Adhering to healthy lifestyle choices.

Conclusion

An individual suffering from HIV may show suggestive symptoms of a cardiovascular condition. Such a case is generally a challenge for healthcare providers and is additionally a growing problem. Sound knowledge of cardiovascular changes due to HIV, the consequences of undergoing antiretroviral therapy, and treatment for other opportunistic infections are mandatory for an accurate diagnosis as well as a long-term treatment plan. It should be understood that the management of a patient with HIV showing clinical manifestations of cardiovascular conditions definitely varies from one patient to another. This is because of the very nature of the combined state. Drug interactions and patient response to a particular treatment and management goals are an area that still needs much research and analysis.