World AIDS Day | Antiretroviral Therapy’s Impact on Cardiovascular Health

World AIDS Day 2023 Introduction:

World AIDS Day 2023 serves as a poignant reminder of the ongoing global battle against HIV/AIDS, urging us to reflect on the progress made and the challenges that persist. Under the theme ‘Let communities lead,’ this year’s focus emphasizes communities’ indispensable role in shaping the HIV response.

To uncover the same, we delve into the global health landscape, the intricacies of HIV, the impact of Modern Antiretroviral Therapy (ART) on PLWDH’s general and cardiac health, and the imperative need for collaborative efforts.

Understanding Human Immunodeficiency Virus:

HIV, or Human Immunodeficiency Virus, remains a formidable adversary as it attacks the immune system, leading to the most advanced stage known as Acquired Immunodeficiency Syndrome (AIDS).

HIV Symptoms and Transmission:

The symptoms of HIV vary, underscoring the importance of early detection. The key is recognizing these signs, from subtle indicators like fever and headaches to more severe manifestations such as weight loss and swollen lymph nodes.

Notably, HIV is not spread through everyday contact like hugs or kisses but through specific body fluids. These modes of transmission include:

• Unprotected Sex: HIV can be transmitted through vaginal, anal, or oral sex with an infected partner, especially if protection, like condoms, is not used.
• Sharing Needles: Injecting drugs with needles or syringes that someone with HIV has used can expose individuals to the virus.
• Mother-to-Child Transmission: HIV can be transmitted from an infected mother to her baby during childbirth, delivery, or breastfeeding.
• Blood Transfusions and Organ Transplants: Though rare, the virus can be transmitted through infected blood or organ donations. Stringent screening measures have significantly reduced this risk.
• Occupational Exposure: Healthcare workers may be at risk if they come into contact with HIV-infected blood through accidental needle pricks or cuts.
• From Mother to Child: HIV can be transmitted during pregnancy, childbirth, or breastfeeding. However, effective antiretroviral therapy (ART) significantly reduces this risk.

Human Immunodeficiency Syndrome Virus Prevention and Treatment:

Condom use, regular testing, medical circumcision, and harm reduction services for drug users are some of the methods that individuals can use to prevent HIV contraction.

While there’s currently no cure for HIV, ART enables individuals to lead healthy lives by suppressing the virus. It is vital not only for the individual’s health but also crucial in preventing further transmission.

Contemporary Antiretroviral Therapy (ART):

Antiretroviral Therapy (ART) has revolutionized the landscape of HIV treatment, offering numerous benefits that significantly impact the health and well-being of individuals living with HIV (PLWH).

The current treatment encompasses various drug classes, including nucleoside reverse transcriptase inhibitors (NRTIs), non-NRTIs (NNRTIs), protease inhibitors (PIs), and integrase strand transfer inhibitors (INSTIs), among others that benefit PLWHs in many ways mentioned below:

1. Viral Suppression:

• Reduced Viral Load: ART effectively suppresses the replication of HIV, leading to a significant reduction in viral load in the bloodstream.
• Undetectable Viral Load: With adherence to ART, many individuals achieve an undetectable viral load, which not only benefits their health but also prevents the sexual transmission of HIV to others.

2. Immune System Restoration:

• CD4 Cell Count Improvement: ART helps restore and maintain CD4 T-cell counts, a crucial immune system component. This prevents opportunistic infections and contributes to overall health improvement.

3. Extended Life Expectancy:

• Near-Normal Lifespan: Effective ART has transformed HIV into a manageable chronic condition, allowing PLWH to lead near-normal lifespans comparable to those without HIV.

4. Prevention of Opportunistic Infections:

• Reduced Opportunistic Infections: ART significantly lowers the risk of opportunistic infections, such as pneumonia, tuberculosis, and fungal infections, which can be life-threatening in individuals with compromised immune systems.

5. Improved Quality of Life:

• Symptom Management: ART alleviates symptoms associated with HIV infection, enhancing the overall quality of life for individuals by reducing fatigue, weight loss, and other HIV-related symptoms.

6. Prevention of Mother-to-Child Transmission:

• Safer Pregnancy and Childbirth: ART has been instrumental in preventing mother-to-child transmission of HIV, allowing HIV-positive mothers to have safer pregnancies and childbirth experiences.

7. Reduced HIV-Related Stigma:

• Normalization of HIV: As ART enables PLWH to lead healthy lives, it contributes to breaking down the stigma associated with HIV. People on successful ART are not only healthier but also less likely to transmit the virus.

8. Prevention of Secondary Infections:

• Lower Risk of Co-Infections: ART reduces the risk of co-infections, such as hepatitis B and C, which can further complicate the health of individuals with HIV.

9. Treatment as Prevention (TasP):

• Reduced Transmission Risk: The concept of Undetectable = Untransmittable (U=U) highlights that individuals with an undetectable viral load due to ART are unlikely to transmit HIV to their sexual partners, contributing to HIV prevention efforts.

10. Adaptability and Personalization:

• Tailored Treatment Plans: ART allows personalized treatment plans that consider individual health, co-existing conditions, and potential drug interactions.

11. Global Public Health Impact:

• Epidemic Control: On a broader scale, widespread use of ART contributes to controlling and eventually ending the HIV epidemic, especially when combined with preventive measures.

As beneficial as ART Therapy is, recent studies suggest that INSTIs and CCR5 antagonists exhibit cardiovascular toxicity, raising valid concerns as it can lead to a higher risk of CVDs.

HIV and Cardiovascular Disease:

HIV infection itself is associated with an increased risk of cardiovascular disease and can double the risk of CVDs, including myocardial infarction and stroke.

Antiretroviral Therapy, Cardiometabolic Side Effects and Cardiovascular Impact

While specific ART classes are not pinpointed as the sole culprits, factors like nadir CD4 count, duration of uncontrolled viremia, and viral load contribute to the prevalence of heart failure in PLWH.

Plus, abacavir, an NRTI, has been linked to an increased risk of myocardial infarction. Further, PIs are known for disturbances in lipid metabolism, and NNRTIs like efavirenz contribute to metabolic changes, highlighting the complexity of assessing CVD risk in PLWH.

Hence, despite the transformative impact of ART on reducing cardiomyopathy and heart failure in PLWH, concerns persist!

Integrating ECG Testing to identify cardiometabolic changes and measure the risk of CVD

Electrocardiogram Machines like Wellnest 12L Pro2 serve as a valuable tools in this endeavor, offering a window into the intricate relationship between ART and cardiovascular health.

By harnessing the power of ECGs, healthcare providers can empower individuals living with HIV to navigate their treatment journey with greater precision, ensuring not only viral suppression but also the preservation of cardiovascular well-being.

1. QT Interval Monitoring

The QT interval on an ECG represents the time it takes for the ventricles of the heart to depolarize and repolarize. Certain antiretroviral medications have been associated with prolongation of the QT interval, potentially leading to a higher risk of ventricular arrhythmias.

2. Assessment of Ischemic Changes:

ECGs can detect ischemic changes in the heart, offering insights into potential cardiovascular issues. Some ART medications may contribute to metabolic changes that increase the risk of coronary artery disease, making regular ECG monitoring crucial.

3. Identification of Arrhythmias:

Antiretroviral medications, particularly protease inhibitors, may influence the electrical conduction system of the heart, leading to arrhythmias. ECGs can identify these abnormalities, enabling timely intervention.

4. ST-Segment Changes:

Changes in the ST segment of an EKG can be indicative of myocardial ischemia or infarction. Monitoring ST-segment changes is essential in recognizing and addressing potential cardiovascular complications associated with ART.

Conclusion:

New promising drugs such as cabenuva and lenacapavir (sunlenca) are undoubtedly transforming the HIV Management landscape. Yet the virus remains a significant public health concern, with a staggering 40.4 million lives lost to HIV and an estimated 39.0 million people living with the virus globally.

To reduce the staggering numbers and improve the quality of life for PLWH, international organizations, including WHO, the Global Fund, and UNAIDS, have aligned their strategies with the Sustainable Development Goal (SDG), aiming to end the HIV epidemic by 2030 and achieve 95% of the target by 2025.

They aim to meet the target by empowering communities, leveraging global strategies, and simultaneously researching and monitoring HIV, ART, and cardiovascular health.

These efforts optimize the long-term well-being of PLWH in the modern treatment era, paving the way for a future where HIV is no longer a global health threat.

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