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Novel insights on HIV/AIDS and cardiac disease: shedding light on the HAART of Darkness

Giuseppe Biondi-Zoccai, Fabrizio D'Ascenzo, Maria Grazia Modena
DOI: http://dx.doi.org/10.1093/eurheartj/ehr413 813-815 First published online: 22 November 2011

This editorial refers to ‘Contribution of the human immunodeficiency virus/acquired immunodeficiency syndrome epidemic to de novo presentations of heart disease in the Heart of Soweto Study cohort’, by K. Sliwa et al., on page 866 and ‘Acute coronary syndromes in human immunodeficiency virus patients: a meta-analysis investigating adverse event rates and the role of antiretroviral therapy’, by F. D'Ascenzo et al., on page 875

Never see him! I saw him clearly then. I shall see this eloquent phantom as long as I live, and I shall see her too, a tragic and familiar shade, resembling in this gesture another one, tragic also, and bedecked with powerless charms, stretching bare brown arms over the glitter of the infernal stream, the stream of darknessJoseph Conrad, Heart of Darkness

The human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) pandemic in Africa and worldwide indeed represents the heart of darkness for any practising physician, given the overwhelming implications in terms of mortality, morbidity, and resource use.1 While innumerable studies have been conducted on HIV/AIDS and more will rightfully come, the impact of this condition on cardiovascular health is still far from clear. Indeed, HIV/AIDS is only (at least apparently) 31 years old,2 and the introduction of potent drug combinations [namely highly active antiretroviral therapy (HAART)] even more recent.3

Given these ongoing improvements in our understanding and treatment of HIV/AIDS as a whole, leading to increased life expectancy in patients with HIV/AIDS, greater attention has been paid to the impact of this condition on other body organs and systems, in light of the pleomorphic manifestations of HIV infection, opportunistic diseases, and drug toxicities.

The heart is now key for the prognosis of HIV/AIDS patients in developed countries, as cardiovascular disease is the most common cause of death …