avkАрхивъ внутренней медициныThe Russian Archives of Internal Medicine2226-67042411-6564“SINAPS” LLC10.20514/2226-6704-2026-16-3-165-174AEVCHOavk-2277Research ArticleОБЗОРНЫЕ СТАТЬИREVIEW ARTICLESИммунные и метаболические механизмы развития и современные подходы к терапии сердечной недостаточности у пациентов с ВИЧ-инфекциейImmune And Metabolic Mechanisms of Development and Modern Approaches to The Treatment of Heart Failure in Patients with HIV Infectionhttps://orcid.org/0009-0004-5425-584XГазиеваЭ. В.GazievaE. V.

Газиева Элина Вельтнуровна — студент 5 курса, лечебный факультет  

Москва 

Elina V. Gazieva — student 5 th year, Faculty of Medicine 

Moscow 

forib@inbox.ruhttps://orcid.org/0009-0001-2402-7684ГавриловА. А.GavrilovA. A.

Гаврилов Антоний Алексеевич — студент, 5 курс, факультет институт клинической медицины 

Москва 

Anthony A. Gavrilov — student, 5 th year, Faculty of Clinical Medicine 

Moscow 

Gavrilovantonii14@yandex.ruhttps://orcid.org/0009-0006-9984-6664СулимоваА. А.SulimovaA. A.

Сулимова Агата Алексеевна — студент, 5 курс, педиатрический факультет 

Уфа 

Agata A. Sulimova — student, 5 th year, Faculty of Pediatrics 

Ufa 

agata0206@mail.ruhttps://orcid.org/0009-0002-7524-3536АкимоваА. Г.AkimovaA. G.

Акимова Александра Геннадиевна — студент, 5 курс, Лечебный факультет 

Москва 

Alexandra G. Akimova — student, 5 th year, Faculty of Medicine 

Moscow 

aag_2003@mail.ruhttps://orcid.org/0009-0001-8048-2681МикитюкД. А.MikityukD. A.

Микитюк Диана Александровна — студент, 5 курс, Лечебный факультет 

Пермь 

Diana A. Mikityuk — student, 5 th year, Faculty of Medicine 

Perm 

diana_mikityuk@mail.ruhttps://orcid.org/0009-0007-0053-6314ПысинаМ. В.PysinaM. V.

Пысина Мария Вячеславовна — студент, 5 курс, Лечебный факультет 

Москва 

Maria V. Pysina — student, 5th year, Faculty of Medicine

Moscow  

Mrn.maria@mail.ruhttps://orcid.org/0009-0008-0905-7229ЗашезовА. А.ZashezovA. A.

Зашезов Астемир Анзорович — студент, 5 курс, Лечебный факультет 

Москва 

Astemir A. Zashezov — student, 5 th year, Faculty of Medicine 

Moscow 

zashezov_astemir@mail.ruhttps://orcid.org/0009-0002-1073-9397ОрищенкоА. В.OrischenkoA. V.

Орищенко Алена Витальевна — студент, 5 курс, Лечебный факультет 

Краснодар 

Alena V. Orischenko — student, 5 th year, Faculty of Medicine 

Krasnodar 

alyona03112002@mail.ruhttps://orcid.org/0009-0003-2848-254XКоролеваЕ. С.KorolevaE. S.

Королева Елена Сергеевна — студент, 5 курс, институт педиатрии 

Самара 

Elena S. Koroleva — student, 5 th year, Institute of Pediat rics 

Samara 

elena.koroleva.2002@mail.ruhttps://orcid.org/0009-0000-1854-1698КомиссароваД. А.KomissarovaD. A.

Комиссарова Дарья Андреевна — студент, 5 курс, Лечебный факультет 

Саратов 

Darya A. Komissarova — student, 5 th year, Faculty of Medicine 

Saratov 

darya.komissarova.002@gmail.comhttps://orcid.org/0009-0007-7087-7720КовалевскаяН. В.KovalevskayaN. V.

Ковалевская Наталья Владимировна — студент, 5 курс, педиатрический факультет 

Ростов-На-Дону 

Natalia V. Kovalevskaya — student, 5 th year, Faculty of Pediatrics 

Rostov-on-Don 

kovalevskayanatasha0@gmail.comhttps://orcid.org/0009-0008-8205-1181БелянинМ. С.BelyaninM. S.

Белянин Максим Сергеевич — студент, 5 курс, лечебный факультет 

 Нижний Новгород 

Maxim S. Belyanin — student, 5th year, Faculty of Medicine 

Nizhny Novgorod 

maksimka_belyanin@bk.ruРоссийский университет медицины Минздрава РоссииРоссияRussian University of MedicineRussian FederationПервый Московский государственный медицинский университет имени И.М. СеченоваРоссияFirst Moscow State Medical University named after I.M. SechenovRussian FederationБашкирский государственный медицинский университетРоссияBashkir State Medical UniversityRussian FederationПермский государственный медицинский университет им. академика Е.А. ВагнераРоссияPerm State Medical University named after Academician E.A. WagnerRussian FederationРоссийский национальный исследовательский медицинский университет им. Н.И. ПироговаРоссияRussian National Research Medical University named after N.I. PirogovRussian FederationРоссийский университет медициныРоссияRussian University of MedicineRussian FederationКубанский государственный медицинский университетРоссияKuban State Medical UniversityRussian FederationСамарский государственный медицинский университетРоссияSamara State Medical UniversityRussian FederationСаратовский государственный медицинский университет (СГМУ) имени В.И. РазумовскогоРоссияSaratov State Medical University named after V.I. RazumovskyRussian FederationРостовский Государственный Медицинский УниверситетРоссияRussian University of MedicineRussian FederationНациональный исследовательский Нижегородский государственный университет им. Н.И. ЛобачевскогоРоссияLobachevsky State University of Nizhny NovgorodRussian Federation202604062026163165174Copyright © Газиева Э.В., Гаврилов А.А., Сулимова А.А., Акимова А.Г., Микитюк Д.А., Пысина М.В., Зашезов А.А., Орищенко А.В., Королева Е.С., Комиссарова Д.А., Ковалевская Н.В., Белянин М.С., 20262026Газиева Э.В., Гаврилов А.А., Сулимова А.А., Акимова А.Г., Микитюк Д.А., Пысина М.В., Зашезов А.А., Орищенко А.В., Королева Е.С., Комиссарова Д.А., Ковалевская Н.В., Белянин М.С.Gazieva E.V., Gavrilov A.A., Sulimova A.A., Akimova A.G., Mikityuk D.A., Pysina M.V., Zashezov A.A., Orischenko A.V., Koroleva E.S., Komissarova D.A., Kovalevskaya N.V., Belyanin M.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.medarhive.ru/jour/article/view/2277

Сердечная недостаточность (СН) остаётся одной из ключевых причин заболеваемости и смертности у пациентов с ВИЧ-инфекцией. За последние десятилетия фенотипы СН у данной популяции претерпели значительные изменения: если ранее доминировала сердечная недостаточность со сниженной фракцией выброса (СНнФВ), то в настоящее время всё большую клиническую значимость приобретает сердечная недостаточность с сохранённой фракцией выброса (СНсФВ). Патогенез этих состояний имеет мультифакторный характер и определяется взаимодействием вирус-ассоциированных механизмов, хронического воспаления, дисрегуляции иммунной системы, кардиометаболических нарушений и побочных эффектов антиретровирусной терапии (АРТ). Для СНнФВ характерны процессы, связанные с хроническим воспалением, активацией моноцитов и макрофагов, ускоренным развитием атеросклероза, ишемической болезни сердца и патологическим ремоделированием миокарда. СНсФВ, напротив, ассоциируется преимущественно с системными метаболическими нарушениями — ожирением, инсулинорезистентностью, дислипидемией, нарушением регуляции кишечного барьера и дисфункцией жировой ткани, что ведёт к формированию фенотипа кардиометаболической СН. Особую роль в этих процессах играют метаболическое воспаление и специфическое воздействие АРТ (ингибиторов интегразы, нуклеозидных и ненуклеозидных ингибиторов обратной транскрипции). Понимание иммунных и метаболических механизмов ВИЧ-ассоциированной СН открывает перспективы для разработки новых терапевтических подходов, включающих иммуномодуляцию, коррекцию метаболических нарушений, использование статинов, ингибиторов SGLT2 и агонистов GLP-1. Дальнейшие исследования, направленные на стратификацию пациентов и оценку клинических исходов, имеют решающее значение для оптимизации ведения данной сложной категории больных.

Heart failure (HF) remains one of the leading causes of morbidity and mortality among patients with HIV infection. Over the past decades, the phenotypes of HF in this population have shifted substantially: while heart failure with reduced ejection fraction (HFrEF) was historically predominant, heart failure with preserved ejection fraction (HFpEF) has emerged as an increasingly important clinical manifestation. The pathogenesis of these conditions is multifactorial, driven by virus-related mechanisms, chronic inflammation, immune dysregulation, cardiometabolic disturbances, and adverse effects of antiretroviral therapy (ART). HFrEF in HIV-infected individuals is primarily associated with chronic inflammation, monocyte– macrophage activation, accelerated atherosclerosis, ischemic heart disease, and pathological myocardial remodeling. By contrast, HFpEF is linked to systemic metabolic abnormalities such as obesity, insulin resistance, dyslipidemia, gut barrier dysfunction, and adipose tissue dysregulation, ultimately leading to the cardiometabolic HF phenotype. A central role in this process is played by metabolic inflammation and the impact of ART (including integrase inhibitors, nucleoside and non-nucleoside reverse transcriptase inhibitors). Understanding the immune and metabolic mechanisms of HIVassociated HF opens new opportunities for therapeutic development. Promising approaches include immunomodulation, metabolic correction, and the use of statins, SGLT2 inhibitors, and GLP-1 receptor agonists. Future studies focusing on patient stratification and clinical outcomes are essential for optimizing the management of this complex patient group

сердечная недостаточностьВИЧ-инфекциясердечная недостаточность со сниженной фракцией выбросасердечная недостаточность с сохранённой фракцией выбросаиммунное воспалениеметаболические нарушенияантиретровирусная терапияheart failureHIV infectionheart failure with reduced ejection fractionheart failure with preserved ejection fractionimmune inflammationmetabolic disordersantiretroviral therapyReferencesШеховцова Т.А., Дупляков Д.В. ВИЧ-инфекция и патология сердечно-сосудистой системы. Кардиоваскулярная терапия и профилактика. 2023;22(3):3370. DOI: 10.15829/1728-8800-2023-3370Shekhovtsova T.A., Duplyakov D.V. HIV infection and cardiovascular pathology. Cardiovascular Therapy and Prevention. 2023;22(3):3370. [In Russian] DOI: 10.15829/1728-8800-2023-3370Турсунов Р.А., Канестри В.Г., Симонова Е.Г., и др. Антиретровирусная терапия — новая эпоха профилактики вич-инфекции. ВИЧ-инфекция и иммуносупрессии. 2018;10(1):37-46. DOI: 10.22328/2077-9828-2018-10-1-37-46Tursunov R.A., Kanestri V.G., Simonova E.G., et al ANTIRETROVIRUS THERAPY — A NEW EPOCH OF PREVENTION OF HIV INFECTION. HIV Infection and Immunosuppressive Disorders. 2018;10(1):37-46. [In Russian] DOI: 10.22328/2077-9828-2018-10-1-37-46Горячева О.Г., Козиолова Н.А., Терехина Н.А. ВИЧ-ассоции рован ная патология сердечно-сосудистой системы. Российский кардиологический журнал. 2019;(11):148-154. DOI: 10.15829/1560-4071-2019-11-148-154Goryacheva O.G., Koziolova N.A., Terekhina N.A. HIV-associated cardiovascular pathology. Russian Journal of Cardiology. 2019;(11):148-154. [In Russian] DOI: 10.15829/1560-4071-2019-11-148-154Sinha A, Feinstein MJ. Immune Dysregulation in Myocardial Fibrosis, Steatosis, and Heart Failure: Current Insights from HIV and the General Population. Curr HIV/AIDS Rep. 2021;18(1):63-72. doi: 10.1007/s11904- 020-00536-9.Sinha A, Feinstein MJ. Immune Dysregulation in Myocardial Fibrosis, Steatosis, and Heart Failure: Current Insights from HIV and the General Population. Curr HIV/AIDS Rep. 2021;18(1):63-72. doi: 10.1007/s11904- 020-00536-9.Go AS, Reynolds K, Avula HR, et al Human Immunodeficiency Virus Infection and Variation in Heart Failure Risk by Age, Sex, and Ethnicity: The HIV HEART Study. Mayo Clin Proc. 2022;97(3):465-479. doi: 10.1016/j.mayocp.2021.10.004.Go AS, Reynolds K, Avula HR, et al Human Immunodeficiency Virus Infection and Variation in Heart Failure Risk by Age, Sex, and Ethnicity: The HIV HEART Study. Mayo Clin Proc. 2022;97(3):465-479. doi: 10.1016/j.mayocp.2021.10.004.Feinstein MJ, Steverson AB, Ning H, et al Adjudicated Heart Failure in HIV-Infected and Uninfected Men and Women. J Am Heart Assoc. 2018;7(21):e009985. doi: 10.1161/JAHA.118.009985.Feinstein MJ, Steverson AB, Ning H, et al Adjudicated Heart Failure in HIV-Infected and Uninfected Men and Women. J Am Heart Assoc. 2018;7(21):e009985. doi: 10.1161/JAHA.118.009985.Горячева О.Г. Особенности хронической сердечной недостаточности на фоне тромбоцитопении у лиц, инфицированных вирусом иммунодефицита человека. Сибирский журнал клинической и экспериментальной медицины. 2024;39(1):126-134. https://doi.org/10.29001/2073-8552-2024-39-1-126-134Goryacheva O.G. Features of chronic heart failure on the background of thrombocytopenia in persons infected with the human immunodeficiency virus. Siberian Journal of Clinical and Experimental Medicine. 2024;39(1):126-134. (In Russ.) https://doi.org/10.29001/2073-8552-2024-39-1-126-134Heidenreich PA, Bozkurt B, Aguilar D, et al 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2022;145(18):e895-e1032. doi: 10.1161/CIR.0000000000001063.Heidenreich PA, Bozkurt B, Aguilar D, et al 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2022;145(18):e895-e1032. doi: 10.1161/CIR.0000000000001063.Freiberg MS, Chang CH, Skanderson M, et al Association Between HIV Infection and the Risk of Heart Failure With Reduced Ejection Fraction and Preserved Ejection Fraction in the Antiretroviral Therapy Era: Results From the Veterans Aging Cohort Study. JAMA Cardiol. 2017;2(5):536-546. doi: 10.1001/jamacardio.2017.0264.Freiberg MS, Chang CH, Skanderson M, et al Association Between HIV Infection and the Risk of Heart Failure With Reduced Ejection Fraction and Preserved Ejection Fraction in the Antiretroviral Therapy Era: Results From the Veterans Aging Cohort Study. JAMA Cardiol. 2017;2(5):536-546. doi: 10.1001/jamacardio.2017.0264.Yen YF, Ko MC, Yen MY, et al Human Immunodeficiency Virus Increases the Risk of Incident Heart Failure. J Acquir Immune Defic Syndr. 2019;80(3):255-263. doi: 10.1097/QAI.0000000000001917.Yen YF, Ko MC, Yen MY, et al Human Immunodeficiency Virus Increases the Risk of Incident Heart Failure. J Acquir Immune Defic Syndr. 2019;80(3):255-263. doi: 10.1097/QAI.0000000000001917.Erqou S, Lodebo BT, Masri A, et al Cardiac Dysfunction Among People Living With HIV: A Systematic Review and Meta-Analysis. JACC Heart Fail. 2019;7(2):98-108. doi: 10.1016/j.jchf.2018.10.006.Erqou S, Lodebo BT, Masri A, et al Cardiac Dysfunction Among People Living With HIV: A Systematic Review and Meta-Analysis. JACC Heart Fail. 2019;7(2):98-108. doi: 10.1016/j.jchf.2018.10.006.Choi H, Dey AK, Sharma G, et al Etiology and pathophysiology of heart failure in people with HIV. Heart Fail Rev. 2021;26(3):497-505. doi: 10.1007/s10741-020-10048-8.Choi H, Dey AK, Sharma G, et al Etiology and pathophysiology of heart failure in people with HIV. Heart Fail Rev. 2021;26(3):497-505. doi: 10.1007/s10741-020-10048-8.Doria de Vasconcellos H, Post WS, Ervin AM, et al Associations Between HIV Serostatus and Cardiac Structure and Function Evaluated by 2-Dimensional Echocardiography in the Multicenter AIDS Cohort Study. J Am Heart Assoc. 2021;10(7):e019709. doi: 10.1161/JAHA.120.019709.Doria de Vasconcellos H, Post WS, Ervin AM, et al Associations Between HIV Serostatus and Cardiac Structure and Function Evaluated by 2-Dimensional Echocardiography in the Multicenter AIDS Cohort Study. J Am Heart Assoc. 2021;10(7):e019709. doi: 10.1161/JAHA.120.019709.Rivera AS, Sinha A, Ahmad FS, et al Long-Term Trajectories of Left Ventricular Ejection Fraction in Patients With Chronic Inflammatory Diseases and Heart Failure: An Analysis of Electronic Health Records. Circ Heart Fail. 2021;14(8):e008478. doi: 10.1161/CIRCHEARTFAILURE.121.008478.Rivera AS, Sinha A, Ahmad FS, et al Long-Term Trajectories of Left Ventricular Ejection Fraction in Patients With Chronic Inflammatory Diseases and Heart Failure: An Analysis of Electronic Health Records. Circ Heart Fail. 2021;14(8):e008478. doi: 10.1161/CIRCHEARTFAILURE.121.008478.Virani SS, Alonso A, Aparicio HJ, et al Heart Disease and Stroke Statistics-2021 Update: A Report From the American Heart Association. Circulation. 2021;143(8):e254-e743. doi: 10.1161/CIR.0000000000000950.Virani SS, Alonso A, Aparicio HJ, et al Heart Disease and Stroke Statistics-2021 Update: A Report From the American Heart Association. Circulation. 2021;143(8):e254-e743. doi: 10.1161/CIR.0000000000000950.Schiattarella GG, Alcaide P, Condorelli G, et al Immunometabolic Mechanisms of Heart Failure with Preserved Ejection Fraction. Nat Cardiovasc Res. 2022;1(3):211-222. doi: 10.1038/s44161-022-00032-w.Schiattarella GG, Alcaide P, Condorelli G, et al Immunometabolic Mechanisms of Heart Failure with Preserved Ejection Fraction. Nat Cardiovasc Res. 2022;1(3):211-222. doi: 10.1038/s44161-022-00032-w.Wu KC, Woldu B, Post WS, et al Prevention of heart failure, tachyarrhythmias and sudden cardiac death in HIV. Curr Opin HIV AIDS. 2022;17(5):261-269. doi: 10.1097/COH.0000000000000753Wu KC, Woldu B, Post WS, et al Prevention of heart failure, tachyarrhythmias and sudden cardiac death in HIV. Curr Opin HIV AIDS. 2022;17(5):261-269. doi: 10.1097/COH.0000000000000753Buggey J, Yun L, Hung CL, et al HIV and pericardial fat are associated with abnormal cardiac structure and function among Ugandans. Heart. 2020;106(2):147-153. doi: 10.1136/heartjnl-2019-315346.Buggey J, Yun L, Hung CL, et al HIV and pericardial fat are associated with abnormal cardiac structure and function among Ugandans. Heart. 2020;106(2):147-153. doi: 10.1136/heartjnl-2019-315346.Butler J, Greene SJ, Shah SH, et al Diastolic Dysfunction in Patients With Human Immunodeficiency Virus Receiving Antiretroviral Therapy: Results From the CHART Study. J Card Fail. 2020;26(5):371-380. doi: 10.1016/j.cardfail.2019.10.011.Butler J, Greene SJ, Shah SH, et al Diastolic Dysfunction in Patients With Human Immunodeficiency Virus Receiving Antiretroviral Therapy: Results From the CHART Study. J Card Fail. 2020;26(5):371-380. doi: 10.1016/j.cardfail.2019.10.011.González A, Ravassa S, Beaumont J, et al New targets to treat the structural remodeling of the myocardium. J Am Coll Cardiol. 2011;58(18):1833-43. doi: 10.1016/j.jacc.2011.06.058.González A, Ravassa S, Beaumont J, et al New targets to treat the structural remodeling of the myocardium. J Am Coll Cardiol. 2011;58(18):1833-43. doi: 10.1016/j.jacc.2011.06.058.Raidel SM, Haase C, Jansen NR, et al Targeted myocardial transgenic expression of HIV Tat causes cardiomyopathy and mitochondrial damage. Am J Physiol Heart Circ Physiol. 2002;282(5):H1672-8. doi: 10.1152/ajpheart.00955.2001.Raidel SM, Haase C, Jansen NR, et al Targeted myocardial transgenic expression of HIV Tat causes cardiomyopathy and mitochondrial damage. Am J Physiol Heart Circ Physiol. 2002;282(5):H1672-8. doi: 10.1152/ajpheart.00955.2001.Sinha A, Feinstein M. Epidemiology, pathophysiology, and prevention of heart failure in people with HIV. Prog Cardiovasc Dis. 2020;63(2):134-141. doi: 10.1016/j.pcad.2020.01.002Sinha A, Feinstein M. Epidemiology, pathophysiology, and prevention of heart failure in people with HIV. Prog Cardiovasc Dis. 2020;63(2):134-141. doi: 10.1016/j.pcad.2020.01.002Spadaro F, Cecchetti S, Fantuzzi L. Macrophages and Phospholipases at the Intersection between Inflammation and the Pathogenesis of HIV-1 Infection. Int J Mol Sci. 2017;18(7):1390. doi: 10.3390/ijms18071390.Spadaro F, Cecchetti S, Fantuzzi L. Macrophages and Phospholipases at the Intersection between Inflammation and the Pathogenesis of HIV-1 Infection. Int J Mol Sci. 2017;18(7):1390. doi: 10.3390/ijms18071390.Williams DW, Eugenin EA, Calderon TM, et al Monocyte maturation, HIV susceptibility, and transmigration across the blood brain barrier are critical in HIV neuropathogenesis. J Leukoc Biol. 2012;91(3):401-15. doi: 10.1189/jlb.0811394.Williams DW, Eugenin EA, Calderon TM, et al Monocyte maturation, HIV susceptibility, and transmigration across the blood brain barrier are critical in HIV neuropathogenesis. J Leukoc Biol. 2012;91(3):401-15. doi: 10.1189/jlb.0811394.Covino DA, Sabbatucci M, Fantuzzi L. The CCL2/CCR2 Axis in the Pathogenesis of HIV-1 Infection: A New Cellular Target for Therapy? Curr Drug Targets. 2016;17(1):76-110. doi: 10.2174/138945011701151217110917.Covino DA, Sabbatucci M, Fantuzzi L. The CCL2/CCR2 Axis in the Pathogenesis of HIV-1 Infection: A New Cellular Target for Therapy? Curr Drug Targets. 2016;17(1):76-110. doi: 10.2174/138945011701151217110917.Feinstein MJ, Hsue PY, Benjamin LA, et al Characteristics, Prevention, and Management of Cardiovascular Disease in People Living With HIV: A Scientific Statement From the American Heart Association. Circulation. 2019;140(2):e98-e124. doi: 10.1161/CIR.0000000000000695.Feinstein MJ, Hsue PY, Benjamin LA, et al Characteristics, Prevention, and Management of Cardiovascular Disease in People Living With HIV: A Scientific Statement From the American Heart Association. Circulation. 2019;140(2):e98-e124. doi: 10.1161/CIR.0000000000000695.Tseng ZH, Moffatt E, Kim A, et al Sudden Cardiac Death and Myocardial Fibrosis, Determined by Autopsy, in Persons with HIV. N Engl J Med. 2021;384(24):2306-2316. doi: 10.1056/NEJMoa1914279.Tseng ZH, Moffatt E, Kim A, et al Sudden Cardiac Death and Myocardial Fibrosis, Determined by Autopsy, in Persons with HIV. N Engl J Med. 2021;384(24):2306-2316. doi: 10.1056/NEJMoa1914279.Халиков А.А., Кузнецов К.О., Искужина Л.Р., и др. Судебномедицинские аспекты внезапной аутопсия-отрицательной сердечной смерти. Судебно-медицинская экспертиза. 2021;64(3):59-63. https://doi.org/10.17116/sudmed20216403159Khalikov AA, Kuznetsov KO, Iskuzhina LR, et al Forensic aspects of sudden autopsy-negative cardiac death. Forensic Medical Expertise. 2021;64(3):59-63. [Russian]. https://doi.org/10.17116/sudmed20216403159Frazier EL, Sutton MY, Brooks JT, et al Trends in cigarette smoking among adults with HIV compared with the general adult population, United States — 2009-2014. Prev Med. 2018;111:231-234. doi: 10.1016/j.ypmed.2018.03.007.Frazier EL, Sutton MY, Brooks JT, et al Trends in cigarette smoking among adults with HIV compared with the general adult population, United States — 2009-2014. Prev Med. 2018;111:231-234. doi: 10.1016/j.ypmed.2018.03.007.Han B, Compton WM, Jones CM, et al Methamphetamine Use, Methamphetamine Use Disorder, and Associated Overdose Deaths Among US Adults. JAMA Psychiatry. 2021;78(12):1329-1342. doi: 10.1001/jamapsychiatry.2021.2588.Han B, Compton WM, Jones CM, et al Methamphetamine Use, Methamphetamine Use Disorder, and Associated Overdose Deaths Among US Adults. JAMA Psychiatry. 2021;78(12):1329-1342. doi: 10.1001/jamapsychiatry.2021.2588.Dickson SD, Thomas IC, Bhatia HS, et al MethamphetamineAssociated Heart Failure Hospitalizations Across the United States: Geographic and Social Disparities. J Am Heart Assoc. 2021;10(16):e018370. doi: 10.1161/JAHA.120.018370.Dickson SD, Thomas IC, Bhatia HS, et al MethamphetamineAssociated Heart Failure Hospitalizations Across the United States: Geographic and Social Disparities. J Am Heart Assoc. 2021;10(16):e018370. doi: 10.1161/JAHA.120.018370.Martin T, Gianella S, Franklin D, et al Methamphetamine and cardiac disease among people with HIV infection. HIV Med. 2020;21(10):635-641. doi: 10.1111/hiv.12918.Martin T, Gianella S, Franklin D, et al Methamphetamine and cardiac disease among people with HIV infection. HIV Med. 2020;21(10):635-641. doi: 10.1111/hiv.12918.Zheng D, Liwinski T, Elinav E. Inflammasome activation and regulation: toward a better understanding of complex mechanisms. Cell Discov. 2020;6:36. doi: 10.1038/s41421-020-0167-x.Zheng D, Liwinski T, Elinav E. Inflammasome activation and regulation: toward a better understanding of complex mechanisms. Cell Discov. 2020;6:36. doi: 10.1038/s41421-020-0167-x.Mullis C, Swartz TH. NLRP3 Inflammasome Signaling as a Link Between HIV-1 Infection and Atherosclerotic Cardiovascular Disease. Front Cardiovasc Med. 2020;7:95. doi: 10.3389/fcvm.2020.00095.Mullis C, Swartz TH. NLRP3 Inflammasome Signaling as a Link Between HIV-1 Infection and Atherosclerotic Cardiovascular Disease. Front Cardiovasc Med. 2020;7:95. doi: 10.3389/fcvm.2020.00095.Guo H, Gao J, Taxman DJ, et al HIV-1 infection induces interleukin-1β production via TLR8 protein-dependent and NLRP3 inflammasome mechanisms in human monocytes. J Biol Chem. 2014;289(31):21716-26. doi: 10.1074/jbc.M114.566620.Guo H, Gao J, Taxman DJ, et al HIV-1 infection induces interleukin-1β production via TLR8 protein-dependent and NLRP3 inflammasome mechanisms in human monocytes. J Biol Chem. 2014;289(31):21716-26. doi: 10.1074/jbc.M114.566620.Theron AJ, Anderson R, Rossouw TM, Steel HC. The Role of Transforming Growth Factor Beta-1 in the Progression of HIV/AIDS and Development of Non-AIDS-Defining Fibrotic Disorders. Front Immunol. 2017;8:1461. doi: 10.3389/fimmu.2017.01461.Theron AJ, Anderson R, Rossouw TM, Steel HC. The Role of Transforming Growth Factor Beta-1 in the Progression of HIV/AIDS and Development of Non-AIDS-Defining Fibrotic Disorders. Front Immunol. 2017;8:1461. doi: 10.3389/fimmu.2017.01461.Vujkovic-Cvijin I, Somsouk M. HIV and the Gut Microbiota: Composition, Consequences, and Avenues for Amelioration. Curr HIV/AIDS Rep. 2019;16(3):204-213. doi: 10.1007/s11904-019-00441-w.Vujkovic-Cvijin I, Somsouk M. HIV and the Gut Microbiota: Composition, Consequences, and Avenues for Amelioration. Curr HIV/AIDS Rep. 2019;16(3):204-213. doi: 10.1007/s11904-019-00441-w.Colaco NA, Wang TS, Ma Y, et al Transmethylamine-NOxide Is Associated With Diffuse Cardiac Fibrosis in People Living With HIV. J Am Heart Assoc. 2021;10(16):e020499. doi: 10.1161/JAHA.120.020499.Colaco NA, Wang TS, Ma Y, et al Transmethylamine-NOxide Is Associated With Diffuse Cardiac Fibrosis in People Living With HIV. J Am Heart Assoc. 2021;10(16):e020499. doi: 10.1161/JAHA.120.020499.Li X, Geng J, Zhao J, et al Trimethylamine N-Oxide Exacerbates Cardiac Fibrosis via Activating the NLRP3 I nflammasome. Front Physiol. 2019;10:866. doi: 10.3389/fphys.2019.00866.Li X, Geng J, Zhao J, et al Trimethylamine N-Oxide Exacerbates Cardiac Fibrosis via Activating the NLRP3 I nflammasome. Front Physiol. 2019;10:866. doi: 10.3389/fphys.2019.00866.Hsue PY, Li D, Ma Y, et al IL-1β Inhibition Reduces Atherosclerotic Inflammation in HIV Infection. J Am Coll Cardiol. 2018;72(22):2809- 2811. doi: 10.1016/j.jacc.2018.09.038.Hsue PY, Li D, Ma Y, et al IL-1β Inhibition Reduces Atherosclerotic Inflammation in HIV Infection. J Am Coll Cardiol. 2018;72(22):2809- 2811. doi: 10.1016/j.jacc.2018.09.038.Kettelhut A, Bowman E, Funderburg NT. Immunomodulatory and Anti-Inflammatory Strategies to Reduce Comorbidity Risk in People with HIV. Curr HIV/AIDS Rep. 2020;17(4):394-404. doi: 10.1007/s11904-020-00509-y.Kettelhut A, Bowman E, Funderburg NT. Immunomodulatory and Anti-Inflammatory Strategies to Reduce Comorbidity Risk in People with HIV. Curr HIV/AIDS Rep. 2020;17(4):394-404. doi: 10.1007/s11904-020-00509-y.d’Ettorre G, Rossi G, Scagnolari C, et al Probiotic supplementation promotes a reduction in T-cell activation, an increase in Th17 frequencies, and a recovery of intestinal epithelium integrity and mitochondrial morphology in ART-treated HIV-1-positive patients. Immun Inflamm Dis. 2017;5(3):244-260. doi: 10.1002/iid3.160d’Ettorre G, Rossi G, Scagnolari C, et al Probiotic supplementation promotes a reduction in T-cell activation, an increase in Th17 frequencies, and a recovery of intestinal epithelium integrity and mitochondrial morphology in ART-treated HIV-1-positive patients. Immun Inflamm Dis. 2017;5(3):244-260. doi: 10.1002/iid3.160Borlaug BA, Jensen MD, Kitzman DW, et al Obesity and heart failure with preserved ejection fraction: new insights and pathophysiological targets. Cardiovasc Res. 2023;118(18):3434-3450. doi: 10.1093/cvr/cvac120Borlaug BA, Jensen MD, Kitzman DW, et al Obesity and heart failure with preserved ejection fraction: new insights and pathophysiological targets. Cardiovasc Res. 2023;118(18):3434-3450. doi: 10.1093/cvr/cvac120Zile MR, Baicu CF, Gaasch WH. Diastolic heart failure--abnormalities in active relaxation and passive stiffness of the left ventricle. N Engl J Med. 2004;350(19):1953-9. doi: 10.1056/NEJMoa032566.Zile MR, Baicu CF, Gaasch WH. Diastolic heart failure--abnormalities in active relaxation and passive stiffness of the left ventricle. N Engl J Med. 2004;350(19):1953-9. doi: 10.1056/NEJMoa032566.Reddy YNV, Andersen MJ, Obokata M, et al Arterial Stiffening With Exercise in Patients With Heart Failure and Preserved Ejection Fraction. J Am Coll Cardiol. 2017;70(2):136-148. doi: 10.1016/j.jacc.2017.05.029.Reddy YNV, Andersen MJ, Obokata M, et al Arterial Stiffening With Exercise in Patients With Heart Failure and Preserved Ejection Fraction. J Am Coll Cardiol. 2017;70(2):136-148. doi: 10.1016/j.jacc.2017.05.029.Schelbert EB, Fridman Y, Wong TC, et al Temporal Relation Between Myocardial Fibrosis and Heart Failure With Preserved Ejection Fraction: Association With Baseline Disease Severity and Subsequent Outcome. JAMA Cardiol. 2017;2(9):995-1006. doi: 10.1001/jamacardio.2017.2511Schelbert EB, Fridman Y, Wong TC, et al Temporal Relation Between Myocardial Fibrosis and Heart Failure With Preserved Ejection Fraction: Association With Baseline Disease Severity and Subsequent Outcome. JAMA Cardiol. 2017;2(9):995-1006. doi: 10.1001/jamacardio.2017.2511Glezeva N, Voon V, Watson C, et al Exaggerated inflammation and monocytosis associate with diastolic dysfunction in heart failure with preserved ejection fraction: evidence of M2 macrophage activation in disease pathogenesis. J Card Fail. 2015;21(2):167-77. doi: 10.1016/j.cardfail.2014.11.004.Glezeva N, Voon V, Watson C, et al Exaggerated inflammation and monocytosis associate with diastolic dysfunction in heart failure with preserved ejection fraction: evidence of M2 macrophage activation in disease pathogenesis. J Card Fail. 2015;21(2):167-77. doi: 10.1016/j.cardfail.2014.11.004.Shah SJ, Katz DH, Selvaraj S, et al Phenomapping for novel classification of heart failure with preserved ejection fraction. Circulation. 2015;131(3):269-79. doi: 10.1161/CIRCULATIONAHA.114.010637Shah SJ, Katz DH, Selvaraj S, et al Phenomapping for novel classification of heart failure with preserved ejection fraction. Circulation. 2015;131(3):269-79. doi: 10.1161/CIRCULATIONAHA.114.010637Schiattarella GG, Rodolico D, Hill JA. Metabolic inflammation in heart failure with preserved ejection fraction. Cardiovasc Res. 2021;117(2):423-434. doi: 10.1093/cvr/cvaa217.Schiattarella GG, Rodolico D, Hill JA. Metabolic inflammation in heart failure with preserved ejection fraction. Cardiovasc Res. 2021;117(2):423-434. doi: 10.1093/cvr/cvaa217.DeBerge M, Lantz C, Dehn S, et al Hypoxia-inducible factors individually facilitate inflammatory myeloid metabolism and inefficient cardiac repair. J Exp Med. 2021;218(9):e20200667. doi: 10.1084/jem.20200667.DeBerge M, Lantz C, Dehn S, et al Hypoxia-inducible factors individually facilitate inflammatory myeloid metabolism and inefficient cardiac repair. J Exp Med. 2021;218(9):e20200667. doi: 10.1084/jem.20200667.Steffens S, Nahrendorf M, Madonna R. Immune cells in cardiac homeostasis and disease: emerging insights from novel technologies. Eur Heart J. 2022;43(16):1533-1541. doi: 10.1093/eurheartj/ehab842.Steffens S, Nahrendorf M, Madonna R. Immune cells in cardiac homeostasis and disease: emerging insights from novel technologies. Eur Heart J. 2022;43(16):1533-1541. doi: 10.1093/eurheartj/ehab842.Schiattarella GG, Altamirano F, Tong D, et al Nitrosative stress drives heart failure with preserved ejection fraction. Nature. 2019;568(7752):351-356. doi: 10.1038/s41586-019-1100-z.Schiattarella GG, Altamirano F, Tong D, et al Nitrosative stress drives heart failure with preserved ejection fraction. Nature. 2019;568(7752):351-356. doi: 10.1038/s41586-019-1100-z.Lake JE, Currier JS. Metabolic disease in HIV infection. Lancet Infect Dis. 2013;13(11):964-75. doi: 10.1016/S1473-3099(13)70271-8.Lake JE, Currier JS. Metabolic disease in HIV infection. Lancet Infect Dis. 2013;13(11):964-75. doi: 10.1016/S1473-3099(13)70271-8.Kanters S, Renaud F, Rangaraj A, et al Evidence synthesis evaluating body weight gain among people treating HIV with antiretroviral therapy — a systematic literature review and network metaanalysis. EClinicalMedicine. 2022;48:101412. doi: 10.1016/j.eclinm.2022.101412.Kanters S, Renaud F, Rangaraj A, et al Evidence synthesis evaluating body weight gain among people treating HIV with antiretroviral therapy — a systematic literature review and network metaanalysis. EClinicalMedicine. 2022;48:101412. doi: 10.1016/j.eclinm.2022.101412.Calza L, Borderi M, Colangeli V, et al Weight gain in treatment-naive HIV-1 infected patients starting abacavir/lamivudine/dolutegravir or tenofovir alafenamide/emtricitabine/bictegravir. AIDS. 2022;36(1):153-155. doi: 10.1097/QAD.0000000000003063.Calza L, Borderi M, Colangeli V, et al Weight gain in treatment-naive HIV-1 infected patients starting abacavir/lamivudine/dolutegravir or tenofovir alafenamide/emtricitabine/bictegravir. AIDS. 2022;36(1):153-155. doi: 10.1097/QAD.0000000000003063.Mausoléo A, Olivo A, Desjardins D, et al Prolonged Antiretroviral Treatment Induces Adipose Tissue Remodelling Associated with Mild Inflammation in SIV-Infected Macaques. Cells. 2022;11(19):3104. doi: 10.3390/cells11193104Mausoléo A, Olivo A, Desjardins D, et al Prolonged Antiretroviral Treatment Induces Adipose Tissue Remodelling Associated with Mild Inflammation in SIV-Infected Macaques. Cells. 2022;11(19):3104. doi: 10.3390/cells11193104Jung I, Tu-Sekine B, Jin S, et al Dolutegravir Suppresses Thermogenesis via Disrupting Uncoupling Protein 1 Expression and Mitochondrial Function in Brown/Beige Adipocytes in Preclinical Models. J Infect Dis. 2022;226(9):1626-1636. doi: 10.1093/infdis/jiac175.Jung I, Tu-Sekine B, Jin S, et al Dolutegravir Suppresses Thermogenesis via Disrupting Uncoupling Protein 1 Expression and Mitochondrial Function in Brown/Beige Adipocytes in Preclinical Models. J Infect Dis. 2022;226(9):1626-1636. doi: 10.1093/infdis/jiac175.Funderburg NT, Mehta NN. Lipid Abnormalities and Inflammation in HIV Inflection. Curr HIV/AIDS Rep. 2016;13(4):218-25. doi: 10.1007/s11904-016-0321-0.Funderburg NT, Mehta NN. Lipid Abnormalities and Inflammation in HIV Inflection. Curr HIV/AIDS Rep. 2016;13(4):218-25. doi: 10.1007/s11904-016-0321-0.Godfrey C, Bremer A, Alba D, et al Obesity and Fat Metabolism in Human Immunodeficiency Virus-Infected Individuals: Immunopathogenic Mechanisms and Clinical Implications. J Infect Dis. 2019;220(3):420-431. doi: 10.1093/infdis/jiz118.Godfrey C, Bremer A, Alba D, et al Obesity and Fat Metabolism in Human Immunodeficiency Virus-Infected Individuals: Immunopathogenic Mechanisms and Clinical Implications. J Infect Dis. 2019;220(3):420-431. doi: 10.1093/infdis/jiz118.Mori MA, Thomou T, Boucher J, et al Altered miRNA processing disrupts brown/white adipocyte determination and associates with lipodystrophy. J Clin Invest. 2014;124(8):3339-51. doi: 10.1172/JCI73468.Mori MA, Thomou T, Boucher J, et al Altered miRNA processing disrupts brown/white adipocyte determination and associates with lipodystrophy. J Clin Invest. 2014;124(8):3339-51. doi: 10.1172/JCI73468.Lackey DE, Burk DH, Ali MR, et al Contributions of adipose tissue architectural and tensile properties toward defining healthy and unhealthy obesity. Am J Physiol Endocrinol Metab. 2014;306(3):E233-46. doi: 10.1152/ajpendo.00476.2013.Lackey DE, Burk DH, Ali MR, et al Contributions of adipose tissue architectural and tensile properties toward defining healthy and unhealthy obesity. Am J Physiol Endocrinol Metab. 2014;306(3):E233-46. doi: 10.1152/ajpendo.00476.2013.Mach F, Koskinas KC, Roeters van Lennep JE, et al 2025 Focused Update of the 2019 ESC/EAS Guidelines for the management of dyslipidaemias. Eur Heart J. 2025:ehaf190. doi: 10.1093/eurheartj/ehaf190.Mach F, Koskinas KC, Roeters van Lennep JE, et al 2025 Focused Update of the 2019 ESC/EAS Guidelines for the management of dyslipidaemias. Eur Heart J. 2025:ehaf190. doi: 10.1093/eurheartj/ehaf190.Kelly SG, Krueger KM, Grant JL, et al Statin Prescribing Practices in the Comprehensive Care for HIV-Infected Patients. J Acquir Immune Defic Syndr. 2017;76(1):e26-e29. doi: 10.1097/QAI.0000000000001454Kelly SG, Krueger KM, Grant JL, et al Statin Prescribing Practices in the Comprehensive Care for HIV-Infected Patients. J Acquir Immune Defic Syndr. 2017;76(1):e26-e29. doi: 10.1097/QAI.0000000000001454Grinspoon SK, Fitch KV, Zanni MV, et al Pitavastatin to Prevent Cardiovascular Disease in HIV Infection. N Engl J Med. 2023;389(8):687- 699. doi: 10.1056/NEJMoa2304146.Grinspoon SK, Fitch KV, Zanni MV, et al Pitavastatin to Prevent Cardiovascular Disease in HIV Infection. N Engl J Med. 2023;389(8):687- 699. doi: 10.1056/NEJMoa2304146.Anker SD, Butler J, Filippatos G, et al Empagliflozin in Heart Failure with a Preserved Ejection Fraction. N Engl J Med. 2021;385(16):1451-1461. doi: 10.1056/NEJMoa2107038Anker SD, Butler J, Filippatos G, et al Empagliflozin in Heart Failure with a Preserved Ejection Fraction. N Engl J Med. 2021;385(16):1451-1461. doi: 10.1056/NEJMoa2107038Regan JA, Truby LK, Tahir UA, et al Protein biomarkers of cardiac remodeling and inflammation associated with HFpEF and incident events. Sci Rep. 2022;12(1):20072. doi: 10.1038/s41598-022-24226-1.Regan JA, Truby LK, Tahir UA, et al Protein biomarkers of cardiac remodeling and inflammation associated with HFpEF and incident events. Sci Rep. 2022;12(1):20072. doi: 10.1038/s41598-022-24226-1.Kosiborod MN, Abildstrøm SZ, Borlaug BA, et al Semaglutide in Patients with Heart Failure with Preserved Ejection Fraction and Obesity. N Engl J Med. 2023;389(12):1069-1084. doi: 10.1056/NEJMoa2306963.Kosiborod MN, Abildstrøm SZ, Borlaug BA, et al Semaglutide in Patients with Heart Failure with Preserved Ejection Fraction and Obesity. N Engl J Med. 2023;389(12):1069-1084. doi: 10.1056/NEJMoa2306963.Schnell O, Almandoz J, Anderson L, et al CVOT summit report 2024: new cardiovascular, kidney, and metabolic outcomes. Cardiovasc Diabetol. 2025;24(1):187. doi: 10.1186/s12933-025-02700-0.Schnell O, Almandoz J, Anderson L, et al CVOT summit report 2024: new cardiovascular, kidney, and metabolic outcomes. Cardiovasc Diabetol. 2025;24(1):187. doi: 10.1186/s12933-025-02700-0.

The authors declare that there are no conflicts of interest present.