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Canadian Journal of Cardiology

Mechanisms of Arrhythmia and Sudden Cardiac Death in Patients With HIV Infection

Published:December 14, 2018DOI:https://doi.org/10.1016/j.cjca.2018.12.015

      Abstract

      Long-term survival of HIV-infected patients has significantly improved with the use of antiretroviral therapy (ART). As a consequence, cardiovascular diseases are now emerging as an important clinical problem in this population. Sudden cardiac death is the third leading cause of mortality in HIV patients. Twenty percent of patients with HIV who died of sudden cardiac death had previous cardiac arrhythmias including ventricular tachycardia, atrial fibrillation, and other unspecified rhythm disorders. This review presents a summary of HIV-related arrhythmias, associated risk factors specific to the HIV population, and underlying mechanisms. Compared with the general population, patients with HIV have several cardiac conditions and electrophysiological abnormalities. As a result, they have an increased risk of developing severe arrhythmias, that can lead to sudden cardiac death. Possible explanations may be related to non-ART polypharmacy, electrolyte imbalances, and use of substances observed in HIV-infected patients; many of these conditions are associated with alterations in cardiac electrical activity, increasing the risk of arrhythmia and sudden cardiac death. However, clinical and experimental evidence has also revealed that cardiac arrhythmias occur in HIV-infected patients, even in the absence of drugs. This indicates that HIV itself can change the electrophysiological properties of the heart profoundly and cause cardiac arrhythmias and related sudden cardiac death. The current knowledge of the underlying mechanisms, as well as the emerging role of inflammation in these arrhythmias, are discussed here.

      Résumé

      La survie à long terme des patients infectés par le VIH s’est considérablement améliorée grâce à la thérapie antirétrovirale (TAR). En conséquence, les maladies cardiovasculaires sont en voie de devenir un problème clinique important dans cette population. La mort subite d’origine cardiaque se classe au troisième rang des causes de mortalité chez les patients vivant avec le VIH. Vingt pour cent des patients vivant avec le VIH qui sont décédés de mort subite d’origine cardiaque présentaient déjà des arythmies cardiaques comme la tachycardie ventriculaire, la fibrillation auriculaire et d’autres troubles du rythme non précisés. Cet article de synthèse présente un résumé des arythmies liées au VIH, des facteurs de risque associés propres à la population vivant avec le VIH et des mécanismes sous-jacents. Par rapport à la population générale, les patients infectés par le VIH ont davantage de conditions cardiaques et d'anomalies électrophysiologiques. Par conséquent, ils présentent un risque accru de développer des arythmies sévères qui peuvent mener à la mort subite d’origine cardiaque. Ce phénomène pourrait s’expliquer par la polypharmacie s’ajoutant à la TAR, les déséquilibres électrolytiques et l’utilisation de substances que l’on observe chez les patients infectés par le VIH; bon nombre de ces facteurs sont associés à une altération de l’activité électrique cardiaque, augmentant ainsi le risque d’arythmie et de mort subite d’origine cardiaque. Toutefois, les données probantes tant cliniques qu’expérimentales ont également révélé que même en l’absence de médicaments, des arythmies sont présentes chez les patients infectés par le VIH. Autrement dit, le VIH lui-même est capable de causer de profondes modifications des propriétés électrophysiologiques du cœur et d’entraîner des arythmies cardiaques et la mort subite d’origine cardiaque. Les connaissances actuelles au sujet des mécanismes sous-jacents et le rôle émergent de l’inflammation dans ces arythmies sont analysés dans le présent article.
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