The Hidden Link Between HIV and Heart Disease

For decades, human immunodeficiency virus (HIV) was considered primarily an immunological threat. However, advances in treatment have transformed HIV into a manageable chronic condition, revealing a significant and often overlooked complication: cardiovascular disease (CVD). Individuals living with HIV face a substantially increased risk of developing heart problems, and at an earlier age than the general population. This article explores the complex relationship between HIV and heart disease, examining the underlying causes, manifestations, and strategies for risk assessment, and management.

The Rising Prevalence of CVD in People Living with HIV

Globally, nearly 40 million people are living with HIV infection ¹. Thanks to antiretroviral therapy (ART), HIV infection is now a chronic, manageable illness for many with access to medical care. However, this prolonged survival has unveiled a concerning trend: a heightened incidence of CVD in this population. The prevalence of cardiac involvement in individuals with AIDS has been reported to range from 28% to 73% ².

Understanding the Pathogenesis of HIV-Associated CVD

Several factors contribute to the increased risk of CVD in people living with HIV. Chronic inflammation, a hallmark of HIV infection even with ART, plays a crucial role. This persistent inflammation damages blood vessels and promotes the development of atherosclerosis, the buildup of plaque in the arteries. Other biochemical factors and overlapping social determinants of health also contribute to this increased risk ¹.

Recent advances in cardiac imaging and immunology are deepening our understanding of the specific mechanisms driving HIV-associated cardiovascular disease ³. Research is focusing on how HIV directly impacts the heart muscle, potentially leading to cardiomyopathy – a condition where the heart muscle becomes weakened and enlarged.

Clinical Manifestations of HIV-Associated Heart Disease

HIV-associated CVD can manifest in various forms, including:

• Coronary Artery Disease: The most common form, characterized by narrowing of the arteries supplying the heart.
• Heart Failure: A condition where the heart cannot pump enough blood to meet the body’s needs.
• Cardiomyopathy: Weakening of the heart muscle, potentially leading to heart failure.
• Arrhythmias: Irregular heartbeats.
• Pericardial Disease: Inflammation of the sac surrounding the heart.

Risk Assessment and Management

Given the increased risk, careful assessment and management of cardiovascular risk are essential for individuals living with HIV. This includes:

• Regular Monitoring: Routine check-ups to monitor blood pressure, cholesterol levels, and other cardiovascular risk factors.
• Lifestyle Modifications: Adopting a heart-healthy lifestyle, including a balanced diet, regular exercise, and smoking cessation.
• ART Adherence: Maintaining consistent adherence to antiretroviral therapy to control HIV viral load and reduce inflammation.
• Management of Comorbidities: Addressing other health conditions, such as hypertension and diabetes, that can contribute to CVD.

The Future of HIV and Cardiovascular Health

Ongoing research continues to unravel the intricate relationship between HIV and heart disease. A deeper understanding of the underlying mechanisms will pave the way for more targeted prevention and treatment strategies. As people with HIV live longer, proactive cardiovascular care will be paramount in improving their overall health and quality of life. The recent review on HIV-associated cardiomyopathy provides valuable insights for clinicians and researchers in the fields of infectious diseases and cardiology ⁴.

References

1. Ghandakly, E., Moudgil, R., & Holman, K. (2025). Cardiovascular disease in people living with HIV: Risk assessment and management. Cleveland Clinic Journal of Medicine, 92(3), 159–167. https://www.ccjm.org/content/92/3/159
2. Cardiac Manifestations of Acquired Immunodeficiency Syndrome. (n.d.). JAMA Internal Medicine. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/485250
3. HIV-Associated Cardiovascular Disease Pathogenesis: An Emerging. (n.d.). AHA Journals. https://www.ahajournals.org/doi/full/10.1161/CIRCRESAHA.124.323890
4. Awoyemi, T. A., Tolu-Akinnawo, O. Z., Greek, A., Adenuga, O., Asogwa, C., Ekundayo, I., Odusola, O., Fasehun, O. F., Ajayi, M., Ugoala, O., Fasehun, L. K., Adeleke, O. D., Angarone, M. (2025). The hidden link between HIV and cardiomyopathy: unraveling HIV’s impact on the heart. Frontiers in Cardiovascular Medicine, 12. https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2025.1601430/full