The Hidden Link Between HIV and Cardiomyopathy: Unraveling HIV's Impact on the Heart

Oluwaremilekun Zeth Tolu-Akinnawo¹Toluwalase Awoyemi^2*Andrew Greek³Oluwakemi Adenuga⁴Chukwuebuka Asogwa⁵Isaac Ekundayo⁶Olamide Odusola⁵Oyinlola Fasehun⁷Mercy Ajayi⁸Luther-King Fasehun⁹Oluwaseun Dorcas Adeleke¹⁰Michael Angarone¹¹

• ¹Meharry Medical College, Nashville, Tennessee, United States
• ²Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States
• ³College of Osteopathic Medicine, Kansas City University, Kansas City, United States
• ⁴Olabisi Onabanjo University Teaching Hospital, Shagamu, Nigeria
• ⁵College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria
• ⁶Faculty of Clinical sciences, University of Ilorin, Ilorin, Nigeria
• ⁷University of Texas Rio Grande Valley-Knapp Medical Center, Weslaco, TX, United States
• ⁸University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
• ⁹Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, New York, United States
• ¹⁰Sumy State University, Sumy, Ukraine
• ¹¹Division of Infectious Diseases, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States

This comprehensive review examines the complex relationship between human immunodeficiency virus (HIV) and cardiomyopathy, focusing on the underlying molecular mechanisms, clinical manifestations, diagnostic approaches, and treatment strategies. It highlights the significant global health burden posed by HIV and its potential to cause long-term cardiovascular complications. The review investigates the pathogenesis of HIV-associated cardiomyopathy. It elucidates the intricate cellular and molecular pathways involved, including the actions of neutrophils, monocytes, macrophages, and lymphocytes in cardiac inflammation. Key signaling pathways such as TNF-NF-κB and the caspase-1 inflammasome are detailed, as they contribute to cardiac infection and injury. The clinical manifestations of HIV-associated cardiomyopathy are discussed, including fatigue, dyspnea, peripheral edema, and arrhythmias. The review outlines essential diagnostic methods, highlighting the importance of cardiac biomarkers, electrocardiography, and imaging techniques such as echocardiography and cardiac MRI. Treatment strategies are explored, encompassing lifestyle modifications, pharmacological interventions, and advanced therapies. The review underscores the importance of addressing micronutrient deficiencies, particularly selenium, in the management of HIV-associated cardiomyopathy. It also discusses the role of antiretroviral therapy and the potential benefits of intravenous immunoglobulin therapy. Furthermore, this review addresses the evolving perspective on heart transplantation for individuals with HIV. It notes that while HIV was once considered a contraindication for transplantation, recent advancements in antiretroviral therapy have led to a re-evaluation of this stance. Finally, the review identifies future research directions, emphasizing the need for biomarkers to detect at-risk patients, exploration of nutritional factors predisposing individuals to cardiomyopathy, and further investigation into advanced therapies for HIV-associated cardiomyopathy. This review significantly enhances the understanding of HIV-associated cardiomyopathy, providing valuable insights for clinicians and researchers in the fields of infectious diseases and cardiology.