Cardiomyopathy, a disease of the heart muscle, is increasingly recognized as a significant complication for individuals living with HIV, according to a recent review published in Frontiers in Cardiovascular Medicine. The study, authored by a team of researchers from institutions across the United States and Nigeria, details the complex interplay between HIV infection and the development of this often-overlooked cardiac condition.
The review highlights a growing understanding of the molecular mechanisms driving HIV-associated cardiomyopathy. Researchers are focusing on how the virus, even when managed with antiretroviral therapy (ART), can contribute to inflammation and subsequent damage to the heart. Persistent immune activation, a hallmark of HIV infection even in those on ART, is a key factor. Markers of inflammation, such as IL-6 and C-reactive protein, have been linked to increased mortality in people with HIV, and are now understood to play a role in the progression of cardiovascular disease.
The rising incidence of cardiovascular issues in people living with HIV is directly linked to increased life expectancy due to advancements in ART. As individuals with HIV live longer, the long-term effects of the virus on cardiovascular health grow more apparent. A study published in JAMA Internal Medicine reported that the prevalence of cardiac involvement in AIDS patients ranges from 28% to 73%.
The review details several potential pathways contributing to the development of cardiomyopathy. These include clonal hematopoiesis – an age-related accumulation of genetically altered blood cells that can promote inflammation – and “trained immunity,” where immune cells retain a heightened response to stimuli even after the initial trigger has subsided. Changes in lipid metabolism, or lipidomics, are also being investigated as potential contributors to the disease process.
Researchers emphasize the require for improved diagnostic approaches to identify HIV-associated cardiomyopathy early. Advances in cardiac imaging modalities are helping to deepen understanding of the disease’s pathogenesis, but further research is needed to refine diagnostic criteria and develop targeted therapies. The review suggests that a comprehensive understanding of the underlying mechanisms is crucial for developing effective treatment strategies.
The study underscores the importance of addressing cardiovascular health as an integral part of HIV care. The authors note that HIV and ART use are linked to an increased incidence of atherosclerotic cardiovascular disease (ASCVD), and that ongoing inflammation contributes to accelerated ASCVD in people with HIV. The review, published in September 2025, aims to provide clinicians and researchers with valuable insights into this emerging area of concern.
