The first cases of HIV/AIDS were reported 30 years ago in the June 5, 1981 issue of CDC’s Morbidity and Mortality Weekly Report. Today, we all recognize our global and domestic successes, and commit to saving more lives and achieving the goal of an AIDS-free generation. As all hands are on deck to kick out HIV/AIDS, let us examine the cardiovascular complications of HIV to mark World AIDS day (December 1st 2011)

A man in his late 40s once presented to our clinic with progressive shortness of breath and effort intolerance, occasional palpitation, and bilateral leg swelling. He was diagnosed HIV patient few years back while as a routine yearly blood donor; his blood was returned for being tested positive for HIV. He initially denied, but later accepted the truth, and because the CD4 count is still well above 200/cm3, he is yet to commence anti – retroviral drugs.

From our investigations, he was found to have heart disease called dilated cardiomyopathy and presented in heart failure (heart too weak to pump out oxygen to the body systems).  He is currently responding to treatment.

Both HIV and antiretroviral treatment can cause problems that can increase the risk of cardiovascular disease, including heart attacks and stroke. Since the discovery of HIV in the 80s, there has been link between HIV and cardiovascular diseases, it affects both young and the old. The cardiovascular effects are not strictly dependent on the level of CD4 count and can present early in the disease or later.

How does HIV affect the heart?
Pericarditis: this is the inflammation of the special sac covering the heart. It may be the effect of the virus itself or that of opportunistic infection or cancer (conditions that will not occur if the immunity is normal). There is resultant fluid accumulation in the pericardial space (pericardial effusion), which make the heart to run faster than normal and when in excess can lead to sudden stoppage of the heart functions (cardiac tamponade). The commonest cause in this environment is tuberculosis which is treatable.  Present early to your doctor for appropriate treatment.

Dilated cardiomyopathy: This is the type of disease that affects the heart muscles. Ordinarily, the heart muscle is protected from direct HIV virus attack but the supportive structures (interstitial cells) are easily destroyed by it. Heart becomes extremely enlarged, stiff or hardens, thereby making it unable to pump out enough oxygenated blood to the body system. This is the condition the man mentioned above had and he is presently receiving treatment. Selenium, a special mineral is helpful in the management of this condition.

Myocarditis: an uncommon inflammation of the heart muscle. It is transient in most cases with little or no complication. A small number of patients may present in severe symptoms necessitating hospital admission.

Bacterial endocarditis: this is a rare condition in which there is bacterial infection of internal lining of the heart and it is fatal, patients die easily if not treated on time. It is Commoner in HIV patients that abused intravenous drugs in the past. The tricuspid valves (the door that partition the right upper chamber and lower chamber of heart), is the most affected in HIV associated infective endocarditis.

Atherosclerosis: cholesterol metabolism is distorted in HIV infection leading to accumulation of the same in the body. Cholesterol plague is then deposited in the inner lining of the artery resulting in its hardening (atherosclerosis) especially in the carotid arteries, which feed the face and the brain with oxygen –rich blood. In addition, the condition is thought to be related to the medication used to treat HIV. HIV is equally associated with heart attack, a condition which is on the increase in our society.

Pulmonary hypertension: this is high blood pressure in the blood vessels of the lungs. It can lead to right sided heart failure (cor pulmonale).

How does HIV medication increase cardiovascular risk?
Most of the drugs especially protease inhibitors that have been of tremendous assistance in controlling the multiplication of HIV in the body also have effects that increase cardiovascular risk of HIV patients. Researchers have shown the mechanism to be as listed below.
•Increased incidence of type 2 diabetes
•Elevated levels of triglycerides
•Low level of HDL( or “good”) cholesterol
•Abnormal body fat distribution to the abdomen

As HIV patients are getting over the stigmatization associated the disease and having hope of living like any other person with chronic diseases e.g. hypertension, appearances of cardiovascular risks, calls for special attentions. Starting from the basis, prevention is better than cure. Stop HIV by avoiding casual sex and be loyal to your spouses. Avoid indiscriminate use of injection and sharp objects. If you are reading this column and yet you don’t know your HIV status, summon courage and do it today. Even when positive, it’s not a death sentence, drugs are available. There are answers to the increased cardiovascular risks associated with the medication. All these will be mentioned in the next episode.

How I wish the current prevalence of HIV in the country is the true picture of AIDS situation, including those that do not have access to hospitals. You can equally contribute your own quota by knowing your HIV status. Let’s kick out HIV from our communities. It is possible.

Till next week, maintain a healthy heart.