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Since acquired immune deficiency syndrome (AIDS) was first identified in the early 1980s, there has been clear evidence from autopsy reports that there is a link between human immunodeficiency virus (HIV, the virus that causes AIDS) and heart conditions. In fact, researchers with the American Heart Association (AHA) have identified HIV as a known risk factor for heart disease, along with diet, obesity, family history and other risk factors. In fact, people with HIV are almost twice as likely to have a heart attack than people without the virus.
HIV-related cardiac abnormalities affect both children and adults, and they are linked with shortened life expectancy. Heart conditions that have been associated with HIV include:
- Pericarditis. This condition involves an inflammation of the pericardium – a thin sac surrounding the heart. It can cause severe chest pain (especially upon taking a deep breath), shortness of breath and heart failure, if left untreated. Physicians typically keep pericarditis patients in the hospital for several days to observe for any signs of an emergency condition called cardiac tamponade. If this emergency condition develops, the excess fluid in the pericardium will need to be drained through a needle, catheter or by surgery.
- Pleural effusion. Fluid buildup in the space between the lungs and chest wall.
- Pulmonary hypertension. High blood pressure in the blood vessels of the lungs. This can lead to right-sided heart failure (cor pulmonale).
- Dilated cardiomyopathy. A type of heart disease in which the heart muscle is abnormally enlarged, thickened and/or stiffened. As a result, the heart muscle’s ability to pump blood is usually weakened. Some researchers have found a link between cardiomyopathy in AIDS patients and a lack of the mineral, selenium.
- Heart failure. A serious condition in which the heart is not pumping well enough to meet the body’s demand for oxygen. It is sometimes called congestive heart failure because the heart’s failure to pump efficiently often results in congestion in the lungs.
- Myocarditis. An uncommon inflammation of the heart muscle myocardium. Many people who develop myocarditis recover in a few weeks with little or no side effects and no long-term complications. Unfortunately, there are a small number of people who have severe symptoms and must be hospitalized.
- Bacterial endocarditis. A potentially fatal infection of the heart or its lining. This condition is rare in HIV-positive patients who have not used intravenous drugs.
- Atherosclerosis. Known as “hardening of the arteries,” this condition occurs when the arteries that supply oxygen-rich blood to the body become partially blocked with brittle plaque deposits. HIV has been shown to be associated with arteriosclerosis in the carotid arteries, which feed the face and brain with oxygen-rich blood. The condition is thought to be related to the medications used to treat HIV.
- Heart valve disorders. Although several heart valves might be affected in HIV-positive patients, the most dangerous condition is infective endocarditis that occurs in the tricuspid valve. This condition most frequently appears among intravenous (I.V) drug users who are HIV-positive.
It is not fully understood the reason for the prevalence of cardiovascular disorders in people with HIV. Although the virus itself undoubtedly plays a part, researchers have also looked at the role of HIV medications play in the development of heart disease. In recent years, a new therapy known as highly active antiretroviral therapy (HAART) has become available. While this therapy is able to extend the lifespan of HIV-patients, some studies have linked HAART with an increased risk of cardiovascular disease. At least one of the medications included in HAART therapy, protease inhibitors, has been associated with various abnormalities, including:
- Increased incidence of type 2 diabetes
- Elevated levels of triglycerides
- Low levels of HDL (or “good”) cholesterol
- Abnormal body fat distribution to the abdomen (and indication of metabolic syndrome)
In a study conducted in 2005, researchers reported that HAART increases the risk of stroke and cardiovascular or cerebrovascular events by approximately 16 percent. Antiretroviral treatment has also been linked to a higher risk of heart attack (myocardial infarction) in HIV-infected patients.
Despite this increased risk, most physicians recommend continuing with therapy to treat HIV. However, they may adjust medication levels or recommend that patients reduce as many other risk factors as possible through lifestyle modification (e.g. diet, exercise). In addition, physicians may prescribe medications for treating hypertension and hyperlipidemia in HIV-infected patients at risk for cardiovascular problems.
The link between the heart and HIV is well established but not well understood. It is not yet understood whether the heart is damaged by the HIV virus itself or by opportunistic infections (minor infections that become more dangerous in patients with low immunity) caused by the HIV virus. HIV-positive patients are at greater risk of viral infections (e.g., from the cytomegalovirus or herpes simplex) that can injure the heart regardless of HIV status. It has also been shown that newborns of HIV-positive women have an increased risk of heart function abnormalities, even if the infant is HIV-negative.
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