Figure 1.

Evolving epidemiology of heart failure and cardiac dysfunction. The pre-ART era was characterized by AIDS-cardiomyopathy. The post-ART era is characterized by less systolic dysfunction and rising diastolic dysfunction. Major cohort studies have demonstrated an increased risk of heart failure in people with HIV. Both HFpEF and HFrEF are associated with immune dysfunction as characterized by nadir CD4+ T cell count. HFrEF is also associated with viral load while HFpEF is associated with certain ART regimens.

HFpEF, heart failure with preserved ejection fraction; HFrEF, heart failure with reduced ejection fraction; VACS, Veterans Aging Cohort Study; ART, antiretroviral therapy; NRTI, nucleoside reverse transcriptase inhibitor; NNRTI, non-nucleoside reverse transcriptase inhibitor; PI, protease inhibitor; INI, integrase inhibitor; SMART Trial⁴, continuous ART superior to episodic ART guided by CD4+ T cell count; START Trial⁵, early ART initiation at CD4+ T cell count >500/mm³ was beneficial.