“The landscape of cardiovascular and pulmonary diseases in HIV-positive patients in low and middle-income countries (LMICs) is dynamic […] Only with thoughtful and meticulous collaborations will there be appreciation of the true burden of cardiovascular and pulmonary comorbidities in HIV-positive persons living in LMICs and the development of sound strategies to optimally manage and prevent these chronic conditions as a way to improve the world’s health.”
With the advent of effective antiretroviral therapy (ART), HIV is becoming a chronic disease. HIV-seropositive (+) patients on ART can expect to live longer and, as a result, they are at risk of developing chronic noncommunicable diseases related to factors, such as aging, lifestyle, long-term HIV infection, and the potential adverse effects of ART. Although data are incomplete, evidence suggests that even in low- and middle-income countries (LMICs), chronic cardiovascular and pulmonary diseases are increasing in HIV-positive patients. This review summarizes evidence-linking HIV infection to the most commonly cited chronic cardiovascular and pulmonary conditions in LMICs: heart failure, hypertension, coronary artery disease/myocardial infarction, stroke, obstructive lung diseases, and pulmonary arterial hypertension. We describe the observed epidemiology of these conditions, factors affecting expression in LMICs, and key populations that may be at higher risk (ie, illicit drug users and children), and finally, we suggest that strategic areas of research and training intended to counter these conditions effectively. As access to ART in LMICs increases, long-term outcomes among HIV-positive persons will increasingly be determined by a range of associated chronic cardiovascular and pulmonary complications. Actions taken now to identify those conditions that contribute to long-term morbidity and mortality optimize early recognition and diagnosis and implement effective prevention strategies and/or disease interventions are likely to have the greatest impact on limiting cardiovascular and pulmonary disease comorbidity and improving population health among HIV-positive patients in LMICs.
Research priorities include:
- Careful analysis of existing and novel epidemiologic data
- Incorporation of HIV and NCD data capture into existing population surveillance
- Collaborations to elucidate pathways by which HIV and ART impact NCDs
- Health outcomes research
- Close examination of the effect of ART per chronic condition