HIV is a single-stranded
RNA retrovirus from the
Lentivirus family that invades
cells containing specific
membrane receptors and incorporates a
DNA copy of itself into the host’s
genome. Immune
deficiency is the result of
virus and immune-mediated destruction of CD4
lymphocytes caused by continuous high-level
HIV replication.
AIDS is defined by the development of one or more specified
opportunistic infections, tumours, and other conditions. These include oesophageal
candidiasis,
cytomegalovirus CMV
retinitis, pulmonary or
extrapulmonary tuberculosis,
Kaposi sarcoma, and
HIV/
AIDS associated
dementia. Most forms of
HIV-related
heart muscle disease and
pericardial effusion occur at this stage.
Acquired immunodeficiency syndrome (
AIDS) was first recognized in 1981 and is caused by
human immunodeficiency virus (
HIV-1).
HIV-2 causes a
similar illness to
HIV-1 but is less aggressive and has so far been restricted mainly to
western Africa.
HIV/
AIDS is acquired through exposure to infected
body fluid, particularly
blood and
semen; the most common modes of spread are sexual, parenteral (
blood or
blood product recipients,
injection drug users, and
occupational injury) and vertical (
mother to
fetus).
HIV/
AIDS is now the second leading
cause of death in the world, with a global
prevalence of 0.8%. Many cultural and
social factors determine regional patterns of
HIV/
AIDS disease and associated
infections.1 In the
United States and
northern Europe, the
epidemic has predominantly been in men who have sex with men. In northeast
India, the
incidence has been greatest in
injection drug users, but in much of
Southeast Asia, the dominant routes of
transmission have been
heterosexual and from
mother to
child (vertical). With improving
longevity, non-
AIDS conditions are now
accounting for the majority of deaths among individuals receiving
ART, and CV
disease has become an increasingly significant problem in the
HIV population. Deaths due to CV
disease among individuals living with
HIV have ranged from 6.5% to 15% of total deaths. The mechanisms underlying CV
disease in
HIV patients are largely poorly understood but are known to be multifactorial. They include many traditional
risk factors and also factors related to
HIV, such as the side effects of antiretroviral medication. These effects are significant and include metabolic issues, immune activation, chronic
inflammation, microbial translocation, and
co-infection with other viral pathogens such as
cytomegalovirus. Such mechanisms are ongoing even when
HIV infection has been treated; the
CD4 count and
HIV viral load may be controlled, but the
infection has not been cured. At the beginning of the
epidemic,
heart muscle disease (
cardiomyopathy) was the dominant cardiac complication of
HIV infection in the developed world. In contrast,
tuberculous pericarditis and
cardiomyopathy were and still remain important cardiac manifestations of the
disease in
Africa.2,3 Combined
highly active antiretroviral therapy (
HAART) (usually two
nucleoside reverse transcriptase inhibitors [NRTIs] in combination with one or two
protease inhibitors) has changed the pattern of
disease in
developed countries, where premature
coronary artery disease (CAD) and other manifestations of
atherosclerosis are emerging as the most common cardiovascular disorder.