Aspects of HIV-associated cardiovascular pathology against the background of antiretroviral therapy

BACKGROUND: The detection of cardiovascular pathology in patients at various stages of HIV infection is highly relevant. Given the data presented in the scientific medical literature on the negative impact of this infection on the cardiovascular system (CVS), a higher level of mortality in this group of patients from cardiovascular diseases has recently increased several times.

AIM: to identify cardiovascular pathology in patients at different stages of HIV infection (3 and 4), to determine the relationship with antiretroviral therapy (ART) regimens to improve the quality of medical care and disease prognosis.

MATERIALS AND METHODS: We examined 60 patients (outpatient and inpatient) with HIV infection at different stages of the disease from June 2020 to December 2021. Retrospectively, an analysis was performed of electronic medical records of persons registered and observed at the MHC AIDS DZM (supervisor — MD, prof. A.I. Mazus) based on the State Budgetary Healthcare Institution ICB No. 2 DZM. The following were analyzed: age, gender, medical history (terms of the disease, comorbidities), results of an objective examination, routine laboratory blood tests, and ART regimens. Cardiovascular pathology was identified by performing special instrumental diagnostics — ECG, Echo-KG, and Doppler ultrasound of the brachiocephalic arteries —followed by a consultation with a cardiologist in case of abnormalities. Categorical data were described with indications of absolute values and extensive indicators. Quantitative indicators were assessed for compliance with the normal distribution using the Shapiro-Wilk test and the Kolmogorov-Smirnov test. Statistical processing was performed using Microsoft Excel and StatTech v. 1.2.0. Differences were considered statistically significant at p <0.05.

RESULTS: Based on the data presented, it can be noted that the observed group of HIV-infected patients was of middle age (41.3±8.5 years), and men accounted for 78%. Cardiovascular pathology was detected in 38 (63%), and stage 4 HIV infection was 71%. Among the pathologies of the heart, infective endocarditis (IE) with damage to the tricuspid valve (58%) was most often diagnosed, and most of them (77%) had stage 4 HIV infection. An analysis of the intake of ART showed that in patients who did not receive it for the entire period of the disease, such pathology was detected in 68.4% of cases; among patients with late initiation of ART or lack of adherence — in 58% of cases; in those who received ART in a timely and regular manner, cardiovascular pathology was diagnosed five times less often — in 11.8%, which indicates an obstructive effect of ART on the development of cardiovascular pathology in HIV infection. The statistical significance of the development of IE in the group of patients with intravenous use of PAS was revealed, which suggests the influence of drug addiction on the occurrence of heart pathology.

CONCLUSION: The data obtained from this study may have specific practical significance, suggesting criteria for examining patients with HIV infection to identify cardiovascular pathology, which will affect the quality of medical care and the prognosis of the disease.