TY - JOUR
T1 - Coronary artery disease in patients with human immunodeficiency virus infection
AU - Mondal, Pratik
AU - Aljizeeri, Ahmed
AU - Small, Gary
AU - Malhotra, Saurabh
AU - Harikrishnan, Prakash
AU - Affandi, Jacquita S.
AU - Buechel, Ronny R.
AU - Dwivedi, Girish
AU - Al-Mallah, Mouaz H.
AU - Jain, Diwakar
N1 - Publisher Copyright:
© 2020, American Society of Nuclear Cardiology.
PY - 2021/4
Y1 - 2021/4
N2 - The life expectancy of people infected with human immunodeficiency virus (HIV) is rising due to better access to combination anti-retroviral therapy (ART). Although ART has reduced acquired immune deficiency syndrome (AIDS) related mortality and morbidity, there has been an increase in non-AIDS defining illnesses such as diabetes mellitus, hypercholesterolemia and coronary artery disease (CAD). HIV is a disease marked by inflammation which has been associated with specific biological vascular processes increasing the risk of premature atherosclerosis. The combination of pre-existing risk factors, atherosclerosis, ART, opportunistic infections and coagulopathy contributes to rising CAD incidence. The prevalence of CAD has emerged as a major contributor of morbidity in these patients due to longer life expectancy. However, ART has been associated with lipodystrophy, dyslipidemia, insulin resistance, diabetes mellitus and CAD. These adverse effects, along with drug–drug interactions when ART is combined with cardiovascular drugs, result in significant challenges in the care of this group of patients. Exercise tolerance testing, echocardiography, myocardial perfusion imaging, coronary computed tomography angiography and magnetic resonance imaging help in the diagnosis of CAD and heart failure and help predict cardiovascular outcomes in a manner similar to non-infected individuals. This review will highlight the pathogenesis and factors that link HIV to CAD, presentation and treatment of HIV-patients presenting with CAD and review briefly the cardiac imaging modalities used to identify this entity and help prognosticate future outcomes.
AB - The life expectancy of people infected with human immunodeficiency virus (HIV) is rising due to better access to combination anti-retroviral therapy (ART). Although ART has reduced acquired immune deficiency syndrome (AIDS) related mortality and morbidity, there has been an increase in non-AIDS defining illnesses such as diabetes mellitus, hypercholesterolemia and coronary artery disease (CAD). HIV is a disease marked by inflammation which has been associated with specific biological vascular processes increasing the risk of premature atherosclerosis. The combination of pre-existing risk factors, atherosclerosis, ART, opportunistic infections and coagulopathy contributes to rising CAD incidence. The prevalence of CAD has emerged as a major contributor of morbidity in these patients due to longer life expectancy. However, ART has been associated with lipodystrophy, dyslipidemia, insulin resistance, diabetes mellitus and CAD. These adverse effects, along with drug–drug interactions when ART is combined with cardiovascular drugs, result in significant challenges in the care of this group of patients. Exercise tolerance testing, echocardiography, myocardial perfusion imaging, coronary computed tomography angiography and magnetic resonance imaging help in the diagnosis of CAD and heart failure and help predict cardiovascular outcomes in a manner similar to non-infected individuals. This review will highlight the pathogenesis and factors that link HIV to CAD, presentation and treatment of HIV-patients presenting with CAD and review briefly the cardiac imaging modalities used to identify this entity and help prognosticate future outcomes.
KW - Coronary artery disease
KW - anti-retroviral therapy
KW - cardiac magnetic resonance imaging
KW - coronary computed tomography angiogram
KW - echocardiography
KW - human immunodeficiency virus
KW - myocardial perfusion imaging
KW - positron emission tomography
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U2 - 10.1007/s12350-020-02280-4
DO - 10.1007/s12350-020-02280-4
M3 - Review article
C2 - 32820424
AN - SCOPUS:85089738356
SN - 1071-3581
VL - 28
SP - 510
EP - 530
JO - Journal of Nuclear Cardiology
JF - Journal of Nuclear Cardiology
IS - 2
ER -