The ART of HAART: Rapid Recovery of HIV Associated Cardiomyopathy

Document Type

Conference Proceeding

Publication Date

4-1-2025

Publication Title

J Heart Lung Transplant

Abstract

Introduction: Acute systolic heart failure can have a myriad of etiologies. Evaluation of underlying pathophysiology is imperative for subsequent management. Infectious disease etiology remains an important factor, as it may often be reversible in nature. Case Report: A 28 year-old male with no past medical or high risk social history presented to an outside ED with difficulty breathing. He was treated for bronchitis 10 days prior. Due to increased work of breathing on presentation, he was intubated, with subsequent PEA arrest. TTE demonstrated EF 17% without LVH and catheterization revealed no coronary artery disease but low cardiac output and high filling pressures. An Impella CP device was placed for shock support. The course was complicated by altered mentation, hemolysis secondary to MCS, acute kidney injury requiring hemodialysis, congestive hepatopathy, and worsening respiratory status. He was then transferred for care escalation. Myocarditis workup revealed acute HIV infection with viral load 3,819,201 copies/mL and CD4 148 cells/mm3. Hypoxia continued to worsen secondary to PJP Pneumonia. After a multidisciplinary team discussion, the decision was made to escalate to Impella 5.5 as a bridge to recovery or LVAD candidacy; GDMT was started. He was deemed not a cardiac transplant candidate due to his high HIV viral load and immune incompetence. He was started on Bactrim with rapid improvement in respiratory status and his viral load dropped (444 copies/mL) within 3 weeks of HAART. A repeat echocardiogram showed an improvement in the LV function to 35%. Improvement in clinical status allowed Impella wean. He was eventually discharged with full renal recovery. At the last outpatient appointment, he was successfully walking 10,000 steps daily without restriction. Summary: Early recognition of acute decompensated heart failure and consideration of acute HIV illness is imperative. Early intervention can allow for recovery of cardiac function and improvement in functional status. [Formula presented]

Volume

44

Issue

4

First Page

S246

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