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Bajdechi M, Gurghean A, Bataila V, Scafa-Udriște A, Bajdechi GE, Radoi R, Oprea AC, Chioncel V, Mateescu I, Zekra L, Cernat R, Dumitru IM, Rugina S. Particular Aspects Related to CD4+ Level in a Group of HIV-Infected Patients and Associated Acute Coronary Syndrome. Diagnostics (Basel) 2023; 13:2682. [PMID: 37627941 PMCID: PMC10453880 DOI: 10.3390/diagnostics13162682] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/11/2023] [Accepted: 08/13/2023] [Indexed: 08/27/2023] Open
Abstract
People living with HIV infection are at high risk for cardiovascular events due to inflammation and atherosclerosis. Also, some antiretroviral therapies may contribute to the risk of cardiovascular complications. Immune status is highly dependent on the level of lymphocyte T helper CD4+. There are data suggesting that immune status and CD4+ cell count may be involved in the development of cardiovascular complications in these patients. Our study is longitudinal and retrospective and included a total number of 50 patients with HIV infection associated with acute coronary syndrome, divided into two subgroups based on the nadir of CD4+ cells. This study analyzes the relationship between the immune status of HIV patients, assessed by the nadir of the CD4+ T-cell count, and the outcome of these patients. Also, secondary endpoints were the assessment of the magnitude of coronary lesions and of thrombotic and bleeding risk assessed by specific scores. Clinical and biological parameters and also the extension and complexity of coronary lesions were assessed. Although patients with poor immune status had more complex coronary lesions and increased operative risk and bleeding risk at one year, this was not associated with significant differences in major adverse cardiac and cerebrovascular events at the 30-day and 1-year outcomes.
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Affiliation(s)
- Mircea Bajdechi
- Faculty of Medicine, University of Medicine and Pharmacy “Carol Davila” of Bucharest, 050474 Bucharest, Romania; (M.B.); (A.S.-U.); (G.-E.B.); (A.C.O.); (V.C.); (I.M.)
- Doctoral School of Medicine, “Ovidius” University of Constanta, 900470 Constanta, Romania; (L.Z.); (R.C.); (I.M.D.); (S.R.)
| | - Adriana Gurghean
- Faculty of Medicine, University of Medicine and Pharmacy “Carol Davila” of Bucharest, 050474 Bucharest, Romania; (M.B.); (A.S.-U.); (G.-E.B.); (A.C.O.); (V.C.); (I.M.)
| | - Vlad Bataila
- Emergency Clinical Hospital of Bucharest, 014461 Bucharest, Romania
| | - Alexandru Scafa-Udriște
- Faculty of Medicine, University of Medicine and Pharmacy “Carol Davila” of Bucharest, 050474 Bucharest, Romania; (M.B.); (A.S.-U.); (G.-E.B.); (A.C.O.); (V.C.); (I.M.)
- Emergency Clinical Hospital of Bucharest, 014461 Bucharest, Romania
| | - Georgiana-Elena Bajdechi
- Faculty of Medicine, University of Medicine and Pharmacy “Carol Davila” of Bucharest, 050474 Bucharest, Romania; (M.B.); (A.S.-U.); (G.-E.B.); (A.C.O.); (V.C.); (I.M.)
| | - Roxana Radoi
- Clinical Hospital of Infectious and Tropical Disease “Dr. Victor Babes” of Bucharest, 030303 Bucharest, Romania;
| | - Anca Cristiana Oprea
- Faculty of Medicine, University of Medicine and Pharmacy “Carol Davila” of Bucharest, 050474 Bucharest, Romania; (M.B.); (A.S.-U.); (G.-E.B.); (A.C.O.); (V.C.); (I.M.)
- Clinical Hospital of Infectious and Tropical Disease “Dr. Victor Babes” of Bucharest, 030303 Bucharest, Romania;
| | - Valentin Chioncel
- Faculty of Medicine, University of Medicine and Pharmacy “Carol Davila” of Bucharest, 050474 Bucharest, Romania; (M.B.); (A.S.-U.); (G.-E.B.); (A.C.O.); (V.C.); (I.M.)
| | - Iuliana Mateescu
- Faculty of Medicine, University of Medicine and Pharmacy “Carol Davila” of Bucharest, 050474 Bucharest, Romania; (M.B.); (A.S.-U.); (G.-E.B.); (A.C.O.); (V.C.); (I.M.)
| | - Lucia Zekra
- Doctoral School of Medicine, “Ovidius” University of Constanta, 900470 Constanta, Romania; (L.Z.); (R.C.); (I.M.D.); (S.R.)
- Clinical Infectious Disease Hospital of Constanta, 900178 Constanta, Romania
| | - Roxana Cernat
- Doctoral School of Medicine, “Ovidius” University of Constanta, 900470 Constanta, Romania; (L.Z.); (R.C.); (I.M.D.); (S.R.)
- Clinical Infectious Disease Hospital of Constanta, 900178 Constanta, Romania
| | - Irina Magdalena Dumitru
- Doctoral School of Medicine, “Ovidius” University of Constanta, 900470 Constanta, Romania; (L.Z.); (R.C.); (I.M.D.); (S.R.)
- Clinical Infectious Disease Hospital of Constanta, 900178 Constanta, Romania
| | - Sorin Rugina
- Doctoral School of Medicine, “Ovidius” University of Constanta, 900470 Constanta, Romania; (L.Z.); (R.C.); (I.M.D.); (S.R.)
- Clinical Infectious Disease Hospital of Constanta, 900178 Constanta, Romania
- Romanian Academy of Medical Sciences, 030167 Bucharest, Romania
- Academy of Romanian Scientists, 050045 Bucharest, Romania
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Bajdechi M, Gurghean A, Bataila V, Scafa-Udriste A, Radoi R, Oprea AC, Marinescu A, Ion S, Chioncel V, Nicula A, Anastasiou A, Bajdechi GE, Savulescu-Fiedler I, Dumitru IM, Rugina S. Cardiovascular Risk Factors, Angiographical Features and Short-Term Prognosis of Acute Coronary Syndrome in People Living with Human Immunodeficiency Virus: Results of a Retrospective Observational Multicentric Romanian Study. Diagnostics (Basel) 2023; 13:diagnostics13091526. [PMID: 37174918 PMCID: PMC10177561 DOI: 10.3390/diagnostics13091526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 04/19/2023] [Accepted: 04/20/2023] [Indexed: 05/15/2023] Open
Abstract
People living with human immunodeficiency virus have increased cardiovascular risk due to a higher prevalence of traditional and particular risk factors such as chronic inflammation, immune dysregulation, endothelial dysfunction, coagulation abnormalities and antiretroviral therapy. In developed countries, coronary artery disease has become the most frequent cardiovascular disease and an important cause of mortality in these patients. The symptomatology of an acute coronary syndrome can be atypical, and the prevalence of each type of acute coronary syndrome is reported differently. Regarding coronary artery disease severity in people living with HIV, the literature data indicates that the presence of single-vessel disease is akin to that of HIV-negative patients, and their short-term prognosis is unclear. This study aims to assess the clinical characteristics, biological parameters, angiographical features and short-term prognosis of acute coronary syndrome in a cohort of Romanian people living with human immunodeficiency virus.
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Affiliation(s)
- Mircea Bajdechi
- Faculty of Medicine, University of Medicine and Pharmacy "Carol Davila" of Bucharest, 050474 Bucharest, Romania
- Doctoral School of Medicine, "Ovidius" University of Constanta, 900470 Constanta, Romania
| | - Adriana Gurghean
- Faculty of Medicine, University of Medicine and Pharmacy "Carol Davila" of Bucharest, 050474 Bucharest, Romania
| | - Vlad Bataila
- Emergency Clinical Hospital of Bucharest, 014461 Bucharest, Romania
| | - Alexandru Scafa-Udriste
- Faculty of Medicine, University of Medicine and Pharmacy "Carol Davila" of Bucharest, 050474 Bucharest, Romania
- Emergency Clinical Hospital of Bucharest, 014461 Bucharest, Romania
| | - Roxana Radoi
- Clinical Hospital of Infectious and Tropical Disease "Dr. Victor Babes" of Bucharest, 030303 Bucharest, Romania
| | - Anca Cristiana Oprea
- Faculty of Medicine, University of Medicine and Pharmacy "Carol Davila" of Bucharest, 050474 Bucharest, Romania
- Clinical Hospital of Infectious and Tropical Disease "Dr. Victor Babes" of Bucharest, 030303 Bucharest, Romania
| | - Adrian Marinescu
- National Institute of Infectious Disease "Prof. Dr. Matei Bals" of Bucharest, 021105 Bucharest, Romania
| | - Stefan Ion
- Faculty of Medicine, "Titu Maiorescu" University of Bucharest, 040441 Bucharest, Romania
| | - Valentin Chioncel
- Faculty of Medicine, University of Medicine and Pharmacy "Carol Davila" of Bucharest, 050474 Bucharest, Romania
| | - Alina Nicula
- Faculty of Medicine, University of Medicine and Pharmacy "Carol Davila" of Bucharest, 050474 Bucharest, Romania
| | - Achilleas Anastasiou
- Departament of Statistics and Actuarial-Financial Mathematics, Laboratory of Statistics and Data Analysis, University of Aegean, 83200 Samos, Greece
| | - Georgiana-Elena Bajdechi
- Faculty of Medicine, University of Medicine and Pharmacy "Carol Davila" of Bucharest, 050474 Bucharest, Romania
| | - Ilinca Savulescu-Fiedler
- Faculty of Medicine, University of Medicine and Pharmacy "Carol Davila" of Bucharest, 050474 Bucharest, Romania
| | - Irina Magdalena Dumitru
- Doctoral School of Medicine, "Ovidius" University of Constanta, 900470 Constanta, Romania
- Clinical Infectious Disease Hospital of Constanta, 900178 Constanta, Romania
| | - Sorin Rugina
- Doctoral School of Medicine, "Ovidius" University of Constanta, 900470 Constanta, Romania
- Clinical Infectious Disease Hospital of Constanta, 900178 Constanta, Romania
- Romanian Academy of Medical Sciences, 030167 Bucuresti, Romania
- Academy of Romanian Scientists, 030167 Bucuresti, Romania
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Pennefather C, Esterhuizen T, Doubell A, Decloedt EH. The 12-month period prevalence and cardiac manifestations of HIV in patients with acute coronary syndrome at a tertiary hospital in Cape Town, South Africa: a retrospective cross-sectional study. BMC Infect Dis 2021; 21:657. [PMID: 34233630 PMCID: PMC8261984 DOI: 10.1186/s12879-021-06367-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 06/28/2021] [Indexed: 11/21/2022] Open
Abstract
Background HIV-positive patients are increasingly being affected by non-communicable diseases such as coronary artery disease (CAD). Data from high-income countries (HICs) indicate that HIV-positive patients have different risk-factor profiles for acute coronary syndrome (ACS) as well as different cardiac manifestations of this syndrome compared to HIV-negative patients. There is limited data from Sub-Saharan Africa (SSA), and particularly from South Africa with the biggest HIV epidemic in the world. The objective of this study was to determine the 12-month period prevalence of HIV in patients with ACS and to compare the risk-factor profile, ACS presentation and management between HIV-positive and HIV-negative adults. Methods We included all patients hospitalised with ACS from 01 January to 31 December 2018 in a tertiary hospital, Tygerberg Hospital, in Cape Town, South Africa. The HIV-status of all patients was determined using routine clinical records. We performed multiple conditional logistic regression on HIV-positive and HIV-negative patients (1:3 ratio) to compare the risk factor profile, ACS presentation and management between the groups. Results Among 889 patients, 30 (3.4%) were HIV-positive (95% confidence interval (CI): 2.3–4.8). HIV-positive patients were younger, more frequently men, and had a lower prevalence of medical comorbidities and a family history of CAD. They were more likely to present with ST-elevation myocardial infarction (STEMI) [odd’s ratio (OR) (95% CI): 3.12 (1.2–8.4)], and have single-vessel disease [OR (95% CI): 3.03 (1.2–8.0)]. Angiographic and echocardiographic data, as well as management, did not differ between the groups. Among HIV-positive patients, 17 (65%) were virally suppressed (HIV viral load < 200 copies/mL) with a median CD4+ count of 271 cells/mm3. The majority (20, 67%) of HIV-positive patients were receiving antiretroviral therapy at the time of the ACS. Conclusions We found an HIV-prevalence of 3.4% (95% CI 2.3–4.8) in adults with ACS in a high endemic HIV region. HIV-positive patients were younger and more likely to present with STEMIs and single-vessel disease, but had fewer CAD risk factors, suggesting additional mechanisms for the development of ACS.
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Affiliation(s)
- Camilla Pennefather
- Division of Clinical Pharmacology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, PO Box 241, Cape Town, 8000, Republic of South Africa
| | - Tonya Esterhuizen
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Cape Town, 8000, Republic of South Africa
| | - Anton Doubell
- Division of Cardiology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, PO Box 241, Cape Town, 8000, Republic of South Africa
| | - Eric H Decloedt
- Division of Clinical Pharmacology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, PO Box 241, Cape Town, 8000, Republic of South Africa.
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Postigo A, Díez-Delhoyo F, Devesa C, Bruña V, Clavero-Olmos M, Vicent L, Juárez M, Sousa I, Fernández-Avilés F, Martínez-Sellés M. Clinical profile, anatomical features and long-term outcome of acute coronary syndromes in human immunodeficiency virus-infected patients. Intern Med J 2021; 50:1518-1523. [PMID: 31908110 DOI: 10.1111/imj.14744] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 11/18/2019] [Accepted: 12/26/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Long-term prognosis of acute coronary syndromes (ACS) in human immunodeficiency virus (HIV)-infected patients is unknown. AIMS To compare outcomes after ACS in HIV-infected and uninfected patients. METHODS Retrospective observational study. HIV cases were matched with two HIV-uninfected controls for age, sex and type of ACS. RESULTS In 92 HIV patients (mean age 51.3 ± 9.0 years, 7.6% women), the prevalence of cardiovascular risk factors was high (smoking 71.7%; hypertension 41.3%; diabetes 14.1%); dyslipidaemia was more frequent (53 (57.6%) vs 79 (42.9%), P = 0.02) and obesity less common (8 (8.7%) vs 41 (22.3%), P = 0.002) than in controls. Eighty-seven (94.6%) HIV patients had undetectable viral load and 85 (92.4%) were under anti-retroviral therapy. Multivessel disease was more common in HIV patients than in controls (44 (47.8%) vs 71 (39.1%); P = 0.05) as was Killip class 3-4 on admission (9 (9.8%) vs 6 (3.3%); P = 0.04). The rate of in-hospital mortality was similar in both groups (2%), and there were no significant differences in 3-year mortality (10.2% vs 5.7%; P = 0.27). Non-cardiovascular readmissions at 3 years were more frequent in HIV patients than in controls (36.5% vs 7.4%; P < 0.001). Multivariate analysis identified previous coronary artery disease as the strongest predictor of mortality in HIV patients (hazard ratio 4.7, 95% confidence interval 1.4-15.7, P = 0.01), whereas HIV infection was not associated with prognosis. CONCLUSION HIV patients with ACS had more frequent multivessel disease and heart failure than matched controls. However, in-hospital and long-term mortality was similar in both groups. Non-cardiovascular re-hospitalisations were more common in HIV patients.
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Affiliation(s)
- Andrea Postigo
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, CIBERCV, Madrid, Spain
| | - Felipe Díez-Delhoyo
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, CIBERCV, Madrid, Spain
| | - Carolina Devesa
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, CIBERCV, Madrid, Spain
| | - Vanesa Bruña
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, CIBERCV, Madrid, Spain
| | - Marta Clavero-Olmos
- Servicios de Medicina Interna y Urgencias, Hospital Universitario Infanta Elena, Madrid, Spain
| | - Lourdes Vicent
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, CIBERCV, Madrid, Spain
| | - Miriam Juárez
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, CIBERCV, Madrid, Spain
| | - Iago Sousa
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, CIBERCV, Madrid, Spain
| | - Francisco Fernández-Avilés
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, CIBERCV, Madrid, Spain.,Universidad Complutense, Madrid, Spain
| | - Manuel Martínez-Sellés
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, CIBERCV, Madrid, Spain.,Universidad Complutense, Madrid, Spain.,Universidad Europea, Madrid, Spain
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Influence of Human Immunodeficiency Virus Infection on the Management and Outcomes of Acute Myocardial Infarction With Cardiogenic Shock. J Acquir Immune Defic Syndr 2021; 85:331-339. [PMID: 32740372 DOI: 10.1097/qai.0000000000002442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND There are limited data on the outcomes of acute myocardial infarction-cardiogenic shock (AMI-CS) in patients with HIV infection and AIDS. SETTING Twenty percent sample of all US hospitals. METHODS A retrospective cohort of AMI-CS during 2000-2017 from the National Inpatient Sample was evaluated for concomitant HIV and AIDS. Outcomes of interest included in-hospital mortality and use of cardiac procedures. A subgroup analysis was performed for those with and without AIDS within the HIV cohort. RESULTS A total 557,974 AMI-CS admissions were included, with HIV and AIDS in 1321 (0.2%) and 985 (0.2%), respectively. The HIV cohort was younger (54.1 vs. 69.0 years), more often men, of non-White race, uninsured, from a lower socioeconomic status, and with higher comorbidity (all P < 0.001). The HIV cohort had comparable multiorgan failure (37.8% vs. 39.0%) and cardiac arrest (28.7% vs. 27.4%) (P > 0.05). The cohorts with and without HIV had comparable rates of coronary angiography (70.2% vs. 69.0%; P = 0.37) but less frequent early coronary angiography (hospital day zero) (39.1% vs. 42.5%; P < 0.001). The cohort with HIV had higher unadjusted but comparable adjusted in-hospital mortality compared with those without [26.9% vs. 37.4%; adjusted odds ratio 1.04 (95% confidence interval: 0.90 to 1.21); P = 0.61]. In the HIV cohort, AIDS was associated with higher in-hospital mortality [28.8% vs. 21.1%; adjusted odds ratio 4.12 (95% confidence interval: 1.89 to 9.00); P < 0.001]. CONCLUSIONS The cohort with HIV had comparable rates of cardiac procedures and in-hospital mortality; however, those with AIDS had higher in-hospital mortality.
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Boccara F, Mary-Krause M, Potard V, Teiger E, Lang S, Hammoudi N, Chauvet M, Ederhy S, Dufour-Soulat L, Ancedy Y, Nhan P, Adavane S, Steg PG, Funck-Brentano C, Costagliola D, Cohen A. HIV Infection and Long-Term Residual Cardiovascular Risk After Acute Coronary Syndrome. J Am Heart Assoc 2020; 9:e017578. [PMID: 32844734 PMCID: PMC7660787 DOI: 10.1161/jaha.119.017578] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background It is unclear whether HIV infection affects the long-term prognosis after an acute coronary syndrome (ACS). The objective of the current study was to compare rates of major adverse cardiac and cerebrovascular events after a first ACS between people living with HIV (PLHIV) and HIV-uninfected (HIV-) patients, and to identify determinants of cardiovascular prognosis. Methods and Results Consecutive PLHIV and matched HIV- patients with a first episode of ACS were enrolled in 23 coronary intensive care units in France. Patients were matched for age, sex, and ACS type. The primary end point was major adverse cardiac and cerebrovascular events (cardiac death, recurrent ACS, recurrent coronary revascularization, and stroke) at 36-month follow-up. A total of 103 PLHIV and 195 HIV- patients (mean age, 49 years [SD, 9 years]; 94.0% men) were included. After a mean of 36.6 months (SD, 6.1 months) of follow-up, the risk of major adverse cardiac and cerebrovascular events was not statistically significant between PLHIV and HIV- patients (17.8% and 15.1%, P=0.22; multivariable hazard ratio [HR], 1.60; 95% CI, 0.67-3.82 [P=0.29]). Recurrence of ACS was more frequent among PLHIV (multivariable HR, 6.31; 95% CI, 1.32-30.21 [P=0.02]). Stratified multivariable Cox models showed that HIV infection was the only independent predictor for ACS recurrence. PLHIV were less likely to stop smoking (47% versus 75%; P=0.01) and had smaller total cholesterol decreases (-22.3 versus -35.0 mg/dL; P=0.04). Conclusions Although the overall risk of major adverse cardiac and cerebrovascular events was not statistically significant between PLHIV and HIV- individuals, PLHIV had a higher rate of recurrent ACS. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT00139958.
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Affiliation(s)
- Franck Boccara
- Department of Cardiology Faculty of Medicine AP-HP Hôpitaux de l'Est Parisien Hôpital Saint-Antoine Sorbonne Université Paris France.,National Institute of Health and Medical Research INSERM UMR_S 938 Sorbonne Université Paris France
| | - Murielle Mary-Krause
- INSERM Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP) Sorbonne Université Paris France
| | - Valérie Potard
- INSERM Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP) Sorbonne Université Paris France
| | - Emmanuel Teiger
- Interventional Cardiology Unit Henri Mondor University Hospital Assistance Publique Hôpitaux de Paris Créteil France.,Inserm CIC 1430 et U955 Team 3 Henri Mondor University Hospital Créteil France
| | - Sylvie Lang
- Department of Cardiology Faculty of Medicine AP-HP Hôpitaux de l'Est Parisien Hôpital Saint-Antoine Sorbonne Université Paris France
| | - Nadjib Hammoudi
- Inserm UMRS 1166 Institute of Cardiometabolism and Nutrition (ICAN) ACTION Study Group and Institute of Cardiology (AP-HP) Hôpital Pitié-Salpêtrière Sorbonne Université Paris France
| | - Marion Chauvet
- Department of Cardiology Faculty of Medicine AP-HP Hôpitaux de l'Est Parisien Hôpital Saint-Antoine Sorbonne Université Paris France
| | - Stéphane Ederhy
- Department of Cardiology Faculty of Medicine AP-HP Hôpitaux de l'Est Parisien Hôpital Saint-Antoine Sorbonne Université Paris France
| | - Laurie Dufour-Soulat
- Department of Cardiology Faculty of Medicine AP-HP Hôpitaux de l'Est Parisien Hôpital Saint-Antoine Sorbonne Université Paris France
| | - Yann Ancedy
- Department of Cardiology Faculty of Medicine AP-HP Hôpitaux de l'Est Parisien Hôpital Saint-Antoine Sorbonne Université Paris France
| | - Pascal Nhan
- Department of Cardiology Faculty of Medicine AP-HP Hôpitaux de l'Est Parisien Hôpital Saint-Antoine Sorbonne Université Paris France
| | - Saroumadi Adavane
- Department of Cardiology Faculty of Medicine AP-HP Hôpitaux de l'Est Parisien Hôpital Saint-Antoine Sorbonne Université Paris France
| | - Ph Gabriel Steg
- Département Hospitalo-Universitaire (DHU) Fibrose Inflammation Remodelage (FIRE) INSERM U-1148 University Paris Diderot Assistance Publique - Hôpitaux de Paris (AP-HP) Paris France
| | - Christian Funck-Brentano
- Department of Pharmacology INSERM CIC Paris-Est, AP-HP ICAN Pitié-Salpêtrière Hospital Sorbonne Université Paris France
| | - Dominique Costagliola
- INSERM Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP) Sorbonne Université Paris France
| | - Ariel Cohen
- Department of Cardiology Faculty of Medicine AP-HP Hôpitaux de l'Est Parisien Hôpital Saint-Antoine Sorbonne Université Paris France
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Marcus JL, Hurley LB, Prasad A, Zaroff J, Klein DB, Horberg MA, Go AS, DeLorenze GN, Quesenberry CP, Sidney S, Lo JC, Silverberg MJ. Recurrence after hospitalization for acute coronary syndrome among HIV-infected and HIV-uninfected individuals. HIV Med 2018; 20:19-26. [PMID: 30178911 DOI: 10.1111/hiv.12670] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2018] [Indexed: 01/28/2023]
Abstract
OBJECTIVES We evaluated the association of HIV infection and immunodeficiency with acute coronary syndrome (ACS) recurrence, and with all-cause mortality as a secondary outcome, after hospitalization for ACS among HIV-infected and HIV-uninfected individuals. METHODS We conducted a retrospective cohort study within Kaiser Permanente Northern California of HIV-infected and HIV-uninfected adults discharged after ACS hospitalization [types: ST-elevation myocardial infarction (STEMI), non-STEMI, or unstable angina] during 1996-2010. We compared the outcomes of ACS recurrence and all-cause mortality within 3 years, both overall by HIV status and stratified by recent CD4 count, with HIV-uninfected individuals as the reference group. Hazard ratios (HRs) were obtained from Cox regression models with adjustment for age, sex, race/ethnicity, year, ACS type, smoking, and cardiovascular risk factors. RESULTS Among 226 HIV-infected and 86 321 HIV-uninfected individuals with ACS, HIV-infected individuals had a similar risk of ACS recurrence compared with HIV-uninfected individuals [HR 1.08; 95% confidence interval (CI) 0.76-1.54]. HIV infection was independently associated with all-cause mortality after ACS hospitalization overall (HR 2.52; 95% CI 1.81-3.52). In CD4-stratified models, post-ACS mortality was higher for HIV-infected individuals with CD4 counts of 201-499 cells/μL (HR 2.64; 95% CI 1.66-4.20) and < 200 cells/μL (HR 5.41; 95% CI 3.14-9.34), but not those with CD4 counts ≥ 500 cells/μL (HR 0.67; 95% CI 0.22-2.08), compared with HIV-uninfected individuals (P trend < 0.001). CONCLUSIONS HIV infection and immunodeficiency were not associated with recurrence of ACS after hospitalization. All-cause mortality was higher among HIV-infected compared with HIV-uninfected individuals, but there was no excess mortality risk among HIV-infected individuals with high CD4 counts.
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Affiliation(s)
- J L Marcus
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
| | - L B Hurley
- Kaiser Permanente Division of Research, Oakland, CA
| | - A Prasad
- Kaiser Permanente San Francisco Medical Center, San Francisco, CA
| | - J Zaroff
- Kaiser Permanente San Francisco Medical Center, San Francisco, CA
| | - D B Klein
- Kaiser Permanente San Leandro Medical Center, San Leandro, CA
| | - M A Horberg
- Kaiser Permanente Mid-Atlantic Permanente Research Institute, Rockville, MD, USA
| | - A S Go
- Kaiser Permanente Division of Research, Oakland, CA
| | | | | | - S Sidney
- Kaiser Permanente Division of Research, Oakland, CA
| | - J C Lo
- Kaiser Permanente Division of Research, Oakland, CA
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Feinstein MJ, Poole B, Engel Gonzalez P, Pawlowski AE, Schneider D, Provias TS, Palella FJ, Achenbach CJ, Lloyd-Jones DM. Differences by HIV serostatus in coronary artery disease severity and likelihood of percutaneous coronary intervention following stress testing. J Nucl Cardiol 2018; 25:872-883. [PMID: 27739037 PMCID: PMC5391305 DOI: 10.1007/s12350-016-0689-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 09/15/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND HIV-infected persons develop coronary artery disease (CAD) more commonly and earlier than uninfected persons; however, the role of non-invasive testing to stratify CAD risk in HIV is not well defined. METHODS AND RESULTS Patients were selected from a single-center electronic cohort of HIV-infected patients and uninfected controls matched 1:2 on age, sex, race, and type of cardiovascular testing performed. Patients with abnormal echocardiographic or nuclear stress testing who subsequently underwent coronary angiography were included. Logistic regressions were used to assess differences by HIV serostatus in two co-primary endpoints: (1) severe CAD (≥70% stenosis of at least one coronary artery) and (2) performance of percutaneous coronary intervention (PCI). HIV-infected patients (N = 189) were significantly more likely to undergo PCI following abnormal stress test when compared with uninfected persons (N = 319) after adjustment for demographics, CAD risk factors, previous coronary intervention, and stress test type (OR 1.85, 95% CI 1.12-3.04, P = 0.003). No associations between HIV serostatus and CAD were statistically significant, although there was a non-significant trend toward greater CAD for HIV-infected patients. CONCLUSIONS HIV-infected patients with abnormal cardiovascular stress testing who underwent subsequent coronary angiography did not have a significantly greater CAD burden than uninfected controls, but were significantly more likely to receive PCI.
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Affiliation(s)
- Matthew J Feinstein
- Division of Cardiovascular Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, 676 N. St. Clair, Suite 600, Chicago, IL, 60611, USA.
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N. Lakeshore Drive, Suite 1400, Chicago, IL, 60611, USA.
| | - Brian Poole
- Department of Medicine, Beth Israel Deaconness Medical Center, Boston, MA, USA
| | - Pedro Engel Gonzalez
- Department of Medicine, Northwestern University Feinberg School of Medicine, 251 E. Huron, Suite 3-150, Chicago, IL, 60611, USA
| | - Anna E Pawlowski
- Northwestern Medicine Enterprise Data Warehouse, Chicago, IL, 60611, USA
| | - Daniel Schneider
- Northwestern Medicine Enterprise Data Warehouse, Chicago, IL, 60611, USA
| | - Tim S Provias
- Division of Cardiovascular Diseases, Northwestern University Feinberg School of Medicine, 676 N. St. Clair, Suite 600, Chicago, IL, 60611, USA
| | - Frank J Palella
- Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, 251 E. Huron St., Suite 3-150, Chicago, IL, 60611, USA
| | - Chad J Achenbach
- Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, 251 E. Huron St., Suite 3-150, Chicago, IL, 60611, USA
| | - Donald M Lloyd-Jones
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N. Lakeshore Drive, Suite 1400, Chicago, IL, 60611, USA
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9
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Abstract
PURPOSE OF REVIEW The aim of this study was to discuss the most recent research in the management of cardiovascular disease (CVD) in people living with HIV (PLWHIV) with a focus on screening, primary and secondary prevention. RECENT FINDINGS The cause of CVD in PLWHIV is complex and multifactorial and creates a demand for a multifaceted approach to screening and prevention. Current screening and management of CVD risk factors in PLWHIV is suboptimal, reasons for this are not clear and the data are still scarce both in the primary and secondary preventive setting. There are no optimal routine risk screening tools available to accurately detect early and subclinical disease; PLWHIV are undertreated with preventive drugs such as statins and aspirin and antihypertensives; there are still no programmes that have been shown significantly efficient over time with regards to improved smoking cessation, increased physical activity and optimal diet, and recent reports call for intensified focus on HIV-positive women as a particularly vulnerable subgroup. SUMMARY There is a need for further studies investigating barriers to optimal CVD risk factor management in PLWHIV and an increased focus of CVD prevention in HIV-positive women.
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10
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Clement ME, Lin L, Navar AM, Okeke NL, Naggie S, Douglas PS. Lower likelihood of cardiac procedures after acute coronary syndrome in patients with human immunodeficiency virus/acquired immunodeficiency syndrome. Medicine (Baltimore) 2018; 97:e9849. [PMID: 29419696 PMCID: PMC5944660 DOI: 10.1097/md.0000000000009849] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Cardiovascular disease (CVD) is an increasing cause of morbidity and mortality in human immunodeficiency virus (HIV)-infected adults; however, this population may be less likely to receive interventions during hospitalization for acute coronary syndrome (ACS). The degree to which this disparity can be attributed to poorly controlled HIV infection is unknown.In this large cohort study, we used the National Inpatient Sample (NIS) to compare rates of cardiac procedures among patients with asymptomatic HIV-infection, symptomatic acquired immunodeficiency syndrome (AIDS), and uninfected adults hospitalized with ACS from 2009 to 2012. Multivariable analysis was used to compare procedure rates by HIV status, with appropriate weighting to account for NIS sampling design including stratification and hospital clustering.The dataset included 1,091,759 ACS hospitalizations, 0.35% of which (n = 3783) were in HIV-infected patients. Patients with symptomatic AIDS, asymptomatic HIV, and uninfected patients differed by sex, race, and income status. Overall rates of cardiac catheterization and revascularization were 53.3% and 37.4%, respectively. In multivariable regression, we found that relative to uninfected patients, those with symptomatic AIDS were less likely to undergo catheterization (odds ratio [OR] 0.48, confidence interval [CI] 0.43-0.55), percutaneous coronary intervention (OR 0.69, CI 0.59-0.79), and coronary artery bypass grafting (0.75, CI 0.61-0.93). No difference was seen for those with asymptomatic HIV relative to uninfected patients (OR 0.93, CI 0.81-1.07; OR 1.06, CI 0.93-1.21; OR 0.88, CI 0.72-1.06, respectively).We found that lower rates of cardiovascular procedures in HIV-infected patients were primarily driven by less frequent procedures in those with AIDS.
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Affiliation(s)
| | - Li Lin
- Duke Clinical Research Institute
| | - Ann Marie Navar
- Duke Clinical Research Institute
- Division of Cardiology, Duke University, Durham, NC
| | | | - Susanna Naggie
- Division of Infectious Diseases
- Duke Clinical Research Institute
| | - Pamela S. Douglas
- Duke Clinical Research Institute
- Division of Cardiology, Duke University, Durham, NC
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11
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Kupková P, Heczko M, Kaučák V, Kryza R. HIV as a risk factor of coronary artery disease and of acute coronary syndrome. COR ET VASA 2017. [DOI: 10.1016/j.crvasa.2016.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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12
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Bundhun PK, Pursun M, Huang WQ. Does infection with human immunodeficiency virus have any impact on the cardiovascular outcomes following percutaneous coronary intervention?: a systematic review and meta-analysis. BMC Cardiovasc Disord 2017; 17:190. [PMID: 28716008 PMCID: PMC5514470 DOI: 10.1186/s12872-017-0624-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 07/12/2017] [Indexed: 11/27/2022] Open
Abstract
Background A direct link between human immunodeficiency virus (HIV)-infected patients and the risk of cardiovascular diseases (CVD) has been shown in recent scientific research. However, this issue is controversial since other previous reports showed no apparent impact of HIV or its anti-retroviral drugs on the cardiovascular system. We aimed to systematically compare the postinterventional adverse cardiovascular outcomes which were observed in patients with and without HIV infection during a mean follow up period ranging from 1 year to 3 years. Methods Common electronic databases were searched for studies which compared postinterventional adverse cardiovascular outcomes [mortality, myocardial infarction (MI), cardiac death, target vessel revascularization (TVR), target lesion revascularization (TLR), stroke and major adverse cardiac events (MACEs)] in patients with and without HIV infection. Statistical analysis was carried out by the RevMan 5.3 software whereby Odds Ratios (OR) and 95% Confidence Intervals (CIs) were generated. Results Two thousand two hundred and sixty-eight (2268) patients (821 patients were HIV positive and 1147 patients were HIV negative) were analyzed. The current results showed that mortality was not significantly increased among patients who were HIV positive with OR: 1.13, 95% CI: 0.65–1.96; P = 0.66. Cardiac death was also similarly reported with OR: 1.16, 95% CI: 0.50–2.68; P = 0.74. However, even if recurrent MI, TVR, TLR, MACEs and stroke were higher in patients who were HIV positive, with OR: 1.32, 95% CI: 0.88–2.12; P = 0.18, OR: 1.36, 95% CI: 0.88–2.12; P = 0.17, OR: 1.22, 95% CI: 0.72–2.06; P = 0.46, OR: 1.29, 95% CI: 0.89–1.85; P = 0.17 and OR: 1.47, 95% CI: 0.44–4.89; P = 0.53 respectively, these results were not statistically significant. Conclusion Patients who were infected with HIV had similar mortality post coronary intervention compared to patients who were not infected by the virus, during a mean follow-up period of 1–3 years. In addition, no significant increase in MI, TVR, TLR, MACEs and stroke were observed during this follow up period. Therefore, it might be concluded that no apparent impact of HIV on the cardiovascular outcomes was observed post coronary intervention.
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Affiliation(s)
- Pravesh Kumar Bundhun
- Institute of Cardiovascular Diseases, the First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, 530027, People's Republic of China
| | - Manish Pursun
- Guangxi Medical University, Nanning, Guangxi, 530027, People's Republic of China
| | - Wei-Qiang Huang
- Institute of Cardiovascular Diseases, the First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, 530027, People's Republic of China. .,Institute of Cardiovascular Diseases, the First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, 530021, People's Republic of China.
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13
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Abstract
BACKGROUND Wellens syndrome is a pattern of electrocardiographic (ECG) changes in the context of unstable angina characterized with deep inverted T-waves or biphasic T-waves in the precordial leads. These specific ECG changes are highly suggestive of stenosis in the left anterior descending artery (LAD), which can result in acute myocardial infarction, left ventricular dysfunction, or death. Human immunodeficiency virus (HIV) infection is known as an independent risk factor for the cardiovascular disease. CASE REPORT The first case is a 61-year-old African American female with a history of HIV infection who presented with chest pain for 8 h. Electrocardiogram (ECG) showed deep T-waves inversions in leads V3-V6. Emergent cardiac catheterization showed 99% stenosis in the mid-LAD and a drug-eluting stent (DES) was subsequently placed. The second case is a 49-year-old African American female with a medical history of type 2 diabetes mellitus, HIV, active cigarettes smoker admitted for intermittent substernal chest pain of 1-day duration. ECG showed biphasic T-wave in V2 and deep T-waves inversion in V3-V4, coronary angiography showed 95% stenosis in the proximal LAD and a DES was placed. CONCLUSION Wellens syndrome has characteristic ECG changes that indicates LAD stenosis. Early recognition of this syndrome, especially in HIV-infected patients who are high risk for cardiovascular disease, will help to avoid impending myocardial infarction.
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Affiliation(s)
- Bowei Tan
- Department of Medicine, Brookdale University Hospital and Medical Center Department of Cardiology, Brookdale University Hospital and Medical Center, Brooklyn, NY
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14
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Abstract
Over the last 2 decades human immunodeficiency virus (HIV) infection has become a chronic disease requiring long-term management. Aging, antiretroviral therapy, chronic inflammation, and several other factors contribute to the increased risk of cardiovascular disease in patients infected with HIV. In low-income and middle-income countries where antiretroviral therapy access is limited, cardiac disease is most commonly related to opportunistic infections and end-stage manifestations of HIV/acquired immunodeficiency syndrome, including HIV-associated cardiomyopathy, pericarditis, and pulmonary arterial hypertension. Cardiovascular screening, prevention, and risk factor management are important factors in the management of patients infected with HIV worldwide.
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Affiliation(s)
- Gerald S Bloomfield
- Division of Cardiology, Duke Global Health Institute, Duke Clinical Research Institute, Duke University, 2400 Pratt Street, Durham, NC 27705, USA.
| | - Claudia Leung
- Feinberg School of Medicine, Northwestern University, 420 East Superior Street, Chicago, IL 60611, USA
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15
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Improvements over time in short-term mortality following myocardial infarction in HIV-positive individuals. AIDS 2016; 30:1583-96. [PMID: 26950315 DOI: 10.1097/qad.0000000000001076] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Few studies have described mortality and clinical outcomes after myocardial infarction (MI) in the HIV-positive population. This study evaluated changes in short-term mortality after MI in HIV-positive individuals in the D:A:D Study, and investigated possible reasons for any changes seen. DESIGN Prospective cohort study. METHODS Demographic, cardiovascular disease (CVD)/HIV-related characteristics and CVD-related interventions (invasive cardiovascular procedures and drug interventions) were summarized at the time of and following an MI. Associations between calendar year and mortality in the first month after MI were identified using logistic regression with adjustment for confounders, including interventions received in the first month after MI. RESULTS One thousand and eight HIV-positive individuals experiencing an MI over the period 1999-2014 were included. The absolute number of MIs decreased from 214 (1999-2002) to 154 (2011-2014). Whilst the CVD risk profile remained high over time, the HIV status improved. The use of CVD-related interventions after MI appeared to increase over time. The proportion of individuals who died in the first month after MI dropped from 26.6% in 1999-2002 to 8.4% in 2011-2014. Later calendar year was associated with decreased short-term mortality; this effect was attenuated after adjusting for CVD-related interventions received in the first month after MI [odds ratio changed from 0.88 (95% confidence interval 0.83, 0.93) to 0.97 (0.91, 1.02)]. CONCLUSION Improvements in short-term survival after MI appear to be largely driven by improved medical management of CVD risk in HIV-positive individuals after MI. Efforts are still needed to treat CVD risk factors and increase access to CVD-related interventions.
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Trevillyan JM, Hoy JF. Managing Cardiovascular Risk in People Living with HIV. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2016. [DOI: 10.1007/s40506-016-0071-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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17
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Cervellin G, Rastelli G. The clinics of acute coronary syndrome. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:191. [PMID: 27294087 PMCID: PMC4885904 DOI: 10.21037/atm.2016.05.10] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 02/26/2016] [Indexed: 01/24/2023]
Abstract
Risk stratification and management of patients with chest pain continues to be challenging despite considerable efforts made in the last decades by many clinicians and researchers. The throutful evaluation necessitates that the physicians have a high index of suspicion for acute coronary syndrome (ACS) and always keep in mind the myriad of often subtle and atypical presentations of ischemic heart disease, especially in certain patient populations such as the elderly ones. In this article we aim to review and discuss the available evidence on the value of clinical presentation in patients with a suspected ACS, with special emphasis on history, characteristics of chest pain, associated symptoms, atypical presentations, precipitating and relieving factors, drugs, clinical rules and significance of clinical Gestalt.
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18
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Lang S, Boccara F, Mary-Krause M, Cohen A. Epidemiology of coronary heart disease in HIV-infected versus uninfected individuals in developed countries. Arch Cardiovasc Dis 2015; 108:206-15. [DOI: 10.1016/j.acvd.2015.01.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 01/26/2015] [Accepted: 01/26/2015] [Indexed: 10/23/2022]
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Prevalence of ischemic heart disease and management of coronary risk in daily clinical practice: results from a Mediterranean cohort of HIV-infected patients. BIOMED RESEARCH INTERNATIONAL 2014; 2014:823058. [PMID: 25170515 PMCID: PMC4142151 DOI: 10.1155/2014/823058] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 07/10/2014] [Accepted: 07/13/2014] [Indexed: 01/16/2023]
Abstract
Background. There are conflicting data on the prevalence of coronary events and the quality of the management of modifiable cardiovascular risk factors (CVRF) in HIV-infected patients. Methods. We performed a retrospective descriptive study to determine the prevalence of coronary events and to evaluate the management of CVRF in a Mediterranean cohort of 3760 HIV-1-infected patients from April 1983 through June 2011. Results. We identified 81 patients with a history of a coronary event (prevalence 2.15%); 83% of them suffered an acute myocardial infarction. At the time of the coronary event, CVRF were highly prevalent (60.5% hypertension, 48% dyslipidemia, and 16% diabetes mellitus). Other CVRF, such as smoking, hypertension, lack of exercise, and body mass index, were not routinely assessed. After the coronary event, a significant decrease in total cholesterol (P = 0.025) and LDL-cholesterol (P = 0.004) was observed. However, the percentage of patients who maintained LDL-cholesterol > 100 mg/dL remained stable (from 46% to 41%, P = 0.103). Patients using protease inhibitors associated with a favorable lipid profile increased over time (P = 0.028). Conclusions. The prevalence of coronary events in our cohort is low. CVRF prevalence is high and their management is far from optimal. More aggressive interventions should be implemented to diminish cardiovascular risk in HIV-infected patients.
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Escárcega RO, Franco JJ, Mani BC, Vyas A, Tedaldi EM, Bove AA. Cardiovascular disease in patients with chronic human immunodeficiency virus infection. Int J Cardiol 2014; 175:1-7. [DOI: 10.1016/j.ijcard.2014.04.155] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Revised: 03/10/2014] [Accepted: 04/13/2014] [Indexed: 01/11/2023]
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22
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Abstract
The emergence of chronic disease complications in controlled HIV disease has changed the landscape of HIV clinical care. HIV infection confers an increased cardiovascular disease risk, which is thought to be due to a complex interplay of mechanistic factors. While traditional cardiovascular risk factors likely play a role, recent evidence suggests that HIV-associated inflammation and immune activation are important mediators of cardiovascular risk. It is unclear whether established preventative interventions for the general population are applicable to HIV-infected patients, and the need to translate mechanistic knowledge into HIV-specific clinical interventions represents an important priority. Developing strategies to prevent cardiovascular disease in HIV-infected individuals calls for a multidisciplinary approach and represents an opportunity to exert a major public health impact in an at-risk population.
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Affiliation(s)
- Virginia A Triant
- Division of Infectious Diseases, Massachusetts General Hospital and Harvard Medical School, 50 Staniford Street, 9th Floor, Boston, MA 02114, USA.
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23
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Brenner DA, Dela Cruz M, Thomas K, McCabe JM, Ganz P, Hsue PY, Waldo SW. Emergency medical service utilization and door-to-balloon time for HIV-infected individuals with ST-elevation myocardial infarction. Int J Cardiol 2013; 168:4808-9. [DOI: 10.1016/j.ijcard.2013.07.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 07/01/2013] [Indexed: 10/26/2022]
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Davis S, Patel P, Sheikh A, Anabwani G, Tolle MA. Adaptation of a general primary care package for HIV-infected adults to an HIV centre setting in Gaborone, Botswana. Trop Med Int Health 2013; 18:328-43. [PMID: 23289364 DOI: 10.1111/tmi.12041] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND As life expectancy of HIV-infected patients improves due to antiretroviral treatment (ART) and the importance of associated co-morbidities and chronic diseases increases, preventive care will become increasingly important. Adaptation of existing preventive guidelines to local environments will become a priority for HIV treatment programmes. METHODS Guidance from the World Health Organization, a focused evidenced-based literature review, Botswana national guidelines, Botswana-specific morbidity and mortality data and centre-specific data were used to adapt a published general primary care package for limited-resource areas to our centre's specific setting. RESULTS The preventive care package contains recommendations on tuberculosis prevention, malnutrition, depression, cervical and breast cancer, hepatitis B coinfection, cardiovascular risk factors, external injury prevention, domestic violence screening, tobacco and substance-abuse counselling, contraception and screening and treatment of sexually transmitted infections. CONCLUSION This preventive care package addresses the comprehensive health needs of HIV-infected adults in the FMC in an evidence-based manner. The process of combining clinic-specific prevalence data, national guidelines, regional literature and assessment of public-sector resources to adapt an existing general package could be utilised to develop similar guidelines in other resource-limited locales.
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Affiliation(s)
- Stephanie Davis
- Botswana-Baylor Children's Clinical Centre of Excellence, Gaborone, Botswana
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