Epidemiology and Clinical Approach to Heart Failure in Patients with HIV

Heart failure (HF) is a major cause of morbidity and mortality globally. Epidemiologic studies have shown that people living with HIV (PLHIV) have 1.5–2-fold higher risk of heart failure compared with uninfected persons. This may be directly related to the level of HIV control and CD4 count. Women with HIV appear to have a higher risk of HF compared to men with HIV. The pathophysiology of HF in PLHIV is likely multifactorial including direct effects of the HIV virus, comorbid conditions, chronic inflammation, and medications. To date, there are no randomized clinical trials focused on the management of HF in PLHIV; therefore, HF management guidelines for the general population may be applied to PLHIV. There are special considerations for PLHIV undergoing device and advanced HF therapies. Studies have shown that HF therapies may be underutilized in PLHIV resulting in increased risk of adverse outcomes. This chapter discusses the epidemiology, pathophysiology, pharmacologic and non-pharmacologic management, and outcomes of heart failure in PLHIV.