CV

Cardiovascular Manifestations of HIV

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Cardiovascular Manifestations of HIV, HIV related Cardiovascular Complications, HIV Cardiomyopathy

  • See Also
  1. HIV Complications
  • Causes
  • Infection
  1. Mycobacterium
  2. Nocardia
  3. Cryptococcus neoformans
  4. Histoplasma capsulatum
  5. Aspergillus
  6. Cytomegalovirus (CMV)
  7. Epstein-Barr Virus (EBV)
  8. Toxoplasmosis
  • Causes
  • Medication adverse effects
  1. Direct cardiotoxicity
    1. Abacavir (Ziagen)
    2. Lopinavir/Ritonavir (Kaletra)
  2. Dyslipidemia or Lipodystrophy
    1. Protease Inhibitors (especially boosted Protease Inhibitors)
    2. Abacavir
    3. Efavirenz
    4. Elvitegravir/Cobicistat
  • Findings
  1. Common
    1. Coronary Artery Disease
      1. Longstanding HIV carries a coronary disease equivalent risk similar to Diabetes Mellitus
      2. CD4 Count <500 is associated with an increased risk of coronary events (even if it rebounds)
      3. Patients with HIV also have higher rates of Tobacco Abuse and Hypertension
      4. Frieberg (2013) JAMA Intern Med 173(8):614-22 [PubMed]
    2. Cerebrovascular Disease
      1. Secondary to direct HIV neurotoxicity, opportunistic infections, Coagulopathy, chronic inflammation
      2. Patients with HIV also have higher rates of Tobacco Abuse, IVDA, CAD, Hypertension, CKD
      3. Strokes occur at younger ages in HIV patients (esp. with lower CD4 Counts, higher viral loads)
      4. D'Ascenzo (2015) J Cardiovasc Med 16(12):839-43 [PubMed]
    3. Dyslipidemia
      1. Obtain lipid panel and Serum Glucose at time of HIV diagnosis
      2. Repeat lipid panel and Glucose screening at perioidic intervals
      3. Consider Statins if indicated (based on non-HIV Infection guidelines)
        1. Risk of Statin-related Drug Interactions with Protease Inhibitors, NNRTI agents
    4. Dilated Cardiomyopathy (25% advanced HIV)
    5. Left Ventricular Dysfunction (21% advanced HIV)
    6. Myocardial fibrosis
      1. Present in up to 82% of HIV patients and often asymptomatic
  2. Less common
    1. Myocarditis
    2. Pericardial Effusion
    3. Pericarditis
    4. Arrhythmias
  3. Rare Conditions
    1. Endocarditis
  • Symptoms
  1. Most are asymptomatic
  • Signs
  1. Usually clinically silent
  2. Pericardial Effusions (usually sterile) in 25%
  • Management
  1. See Cardiomyopathy
  2. In those with Cardiac Risk Factors, avoid agents with cardiotoxicity risk (see above)
  3. Tobacco Cessation
  4. Hyperlipidemia Management wth Statin indicated for 10 year Cardiac Risk >5 to 7.5%
    1. Risk of Statin-Induced Myopathy
    2. Start with low dose Atorvastatin (Lipitor) 10 mg or Rosuvastatin (Crestor)
  • Reference
  1. (2019) Presc Lett 26(8): 46
  2. Mathieu (April, 2000) Federal Practitioner, p. 18-20
  3. Swaminathan and Bafuma in Herbert (2017) EM:Rap 17(3): 2
  4. Chu (2017) Am Fam Physician 96(3): 161-9 [PubMed]