HIV infection is known to cause opportunistic infections and malignancies. But the heart is also not spared by the ravaging of the virus and is affected in many ways. From the beginning of the AIDS epidemic, it was recognized through tests that HIV infection can cause cardiac abnormalities. Two decades ago it was detected mainly by autopsy. But later on when screened by tests, many HIV positive individuals were diagnosed with heart problems early in the course of the disease when, not advanced clinically. Pericardial effusion (fluid in the outer covering of the heart) and myocarditis (inflammation of the middle layer of the heart) are most common abnormalities. But the inner layer of the heart (endocardium), heart valves and blood vessels, can be involved. The heart can be affected by the common and uncommon infections to which these individuals are prone due to reduced immunity of the body. These are commonly, tuberculosis, fungal infections like cryptococcus, aspergillosis, bacterial infections like Staphylococcus aureus, streptococci. Protozoa like Toxoplasmosis Gondii, viral infections like herpes simplex, cytomegalo virus, e.t.c. can affect the heart. HIV itself is known to damage the heart muscle causing dilated cardiomyopathy. Various malignancies due to HIV like lymphomas and Kaposi’s sarcoma can also invade the heart. Malignancy in any other part of the body may spread to the heart, damaging it. The problem with the primary malignancies is that they usually remain silent for a long time without producing any symptoms, unless a large part of the heart is compressed or damaged. HIV positive persons are prone to a wide variety of lung diseases. These can also cause cardiac failure due to thromboembolism (clot passing from lung tissue or vessels to heart) or pulmonary hypertension (increase in pressure of lung vessels). ARV drugs used for treatment of HIV/AIDS are also known to create heart problems. Zidovudine is known to affect muscles of the body including those of the heart. Protease inhibitors lead to various metabolic abnormalities like increase in dangerous lipid levels, diabetes, central obesity, which make a person more prone to cardiac diseases like angina and heart attacks. Young persons on ARV treatment have been known to develop myocardial infarction. Immune depressed individuals who smoke or consume alcohol and other addictive substances make themselves more susceptible to heart attacks. With advent of ARV (antiretroviral drugs) therapy, longevity of HIV positive persons has increased. Thus their chances of acquiring cardiac problems like hypertension, atherosclerosis associated with aging also increase as compared to other individuals. Thus an HIV positive individual is prone to cardiac problems due to many reasons. These problems usually remain silent in the early stages. They are also overshadowed by several other infections. Breathlessness which is a cardinal early feature of cardiac disease may be presumed to be due to high fever and or pulmonary disease which may also be present, thus missing the cardiac problem. In advanced cardiac disease, there may be other features like swelling of feet and the whole body including lungs, irregular pulse, high blood pressure, abnormal heart sounds, e.t.c. Diagnosis of a heart related problem in an immune depressed person needs a high degree of suspicion and confirmed by tests. An HIV positive person should be evaluated for all risk factors which could affect the heart. Once diagnosed, they should be taught the importance of keeping the body weight under control. Regular physical exercise is as important and beneficial for them as for non HIV infected persons. If they suffer from high blood pressure or diabetes, it should be controlled very well by proper diet and drug therapy. Alcohol and smoking should be dropped as early as possible. A physician also has to be alert to the possibility of infection of the heart in HIV patients and should diagnose them at the earliest by available means. In case of lack of investigative facilities, treatment should be started even when doubting the condition. Careful monitoring can help in early detection and treatment of these heart related problems and thus enhance the quality of lives of those living with HIV. The author is a specialist in Internal Medicine rachna212002@yahoo.co.uk
