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Romancini JLH, Guariglia D, Nardo Jr. N, Herold P, Pimentel GGDA, Pupulin ÁRT. Níveis de atividade física e alterações metabólicas em pessoas vivendo com HIV/AIDS. REV BRAS MED ESPORTE 2012. [DOI: 10.1590/s1517-86922012000600001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Com a introdução da highly active antiretroviral therapy (HAART) - terapia antirretroviral fortemente ativa - o curso da infecção pelo HIV sofreu profundas modificações; ocorreu aumento da sobrevida e melhora na qualidade de vida, com restauração parcial do sistema imune. Após cerca de 10 anos do uso da HAART, começaram a aparecer os efeitos da combinação tratamento/vírus. Estes incluem alterações no metabolismo dos lipídios com hipertrigliceridemia, hipercolesterolemia, resistência insulínica, hiperglicemia e redistribuição da gordura corporal que são fatores de risco para doença cardiovascular. Estudos observacionais em pessoas vivendo com HIV/AIDS mostram que o indivíduo, ao se descobrir portador da doença, acaba sentindo medo ou vergonha, reduzindo o círculo social, atividades de trabalho e lazer, e se isolando em casa ou em pequenos grupos os quais tenham em comum a identidade de portadores HIV/AIDS. O objetivo deste trabalho foi avaliar a relação entre o nível de atividade física habitual e de lazer de pessoas vivendo com HIV/AIDS e sua relação com alterações metabólicas. Os pacientes foram classificados em sedentários e ativos, utilizando o questionário de atividade física habitual proposto por Baecke e validado para pacientes HIV/AIDS. Para classificação utilizou-se as recomendações do Colégio Americano de Medicina do Esporte. O metabolismo foi avaliado por meio das dosagens de glicemia de jejum, colesterol total, HDL-colesterol, LDL-colesterol e triglicérides, utilizando-se kits comerciais. A amostra foi composta por 65 pacientes HIV que utilizavam terapia HAART há pelo menos cinco anos. Foram classificados 64,6% como sedentários e 35,4% ativos. O estudo mostra uma relação direta entre nível de atividade física e melhores níveis de HDL-colesterol em pacientes HIV/AIDS. O HDL-colesterol é uma lipoproteína de proteção cardiovascular e, embora outros parâmetros avaliados não tenham mostrado diferença, estes resultados apontam a necessidade de estudos adicionais sobre fatores de risco e atividade física para pacientes HIV/AIDS, possibilitando propostas de intervenções específicas para esses pacientes.
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Park YI, Sir JJ, Park SW, Kim HT, Lee B, Kwak YK, Cho WH, Choi SK. Acute idiopathic hemorrhagic pericarditis with cardiac tamponade as the initial presentation of acquired immune deficiency syndrome. Yonsei Med J 2010; 51:273-5. [PMID: 20191022 PMCID: PMC2824875 DOI: 10.3349/ymj.2010.51.2.273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2008] [Revised: 06/20/2008] [Accepted: 06/20/2008] [Indexed: 11/27/2022] Open
Abstract
This paper presents a case of cardiac tamponade with idiopathic hemorrhagic pericarditis as the initial symptom of human immunodeficiency virus (HIV) infection. A 29-year-old male came to the emergency room with a sudden onset of dizziness. Upon arrival, he was hypotensive although not tachycardic, and his jugular venous pressure was not elevated. His chest X-rays revealed a mild cardiomegaly. Transthoracic echocardiography revealed a large amount of pericardial effusion with a diastolic collapse of the right ventricle, a dilated inferior vena cava with little change in respiration, and exaggerated respiratory variation of mitral inflow velocities, representing echocardiographic evidence of cardiac tamponade. After pericardiocentesis, his blood pressure improved to 110/70 mmHg without inotropics support. Serial 12-lead electrocardiograms during hospitalization revealed upwardly concave diffuse ST-segment elevation followed by a T-wave inversion suggestive of acute pericarditis. Pericardial fluid cytology and cultures for bacteria, mycobacteria, adenovirus, and fungus were all negative. HIV enzyme-linked immunosorbent assay (ELISA) was positive and confirmed by Western blot. The CD4 cell count was 168/mm(3). Finally, the diagnosis of cardiac tamponade due to HIV-associated hemorrhagic pericarditis was made. It was concluded that HIV infection should be considered in the diagnosis of unexplained pericardial effusion or cardiac tamponade in Korea.
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Affiliation(s)
- Young Il Park
- Cardiovascular Center, Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Jung-Ju Sir
- Cardiovascular Center, Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Sung-Won Park
- Cardiovascular Center, Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Hyun-Tae Kim
- Cardiovascular Center, Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Bora Lee
- Cardiovascular Center, Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Ye-Kyung Kwak
- Cardiovascular Center, Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Wook-Hyun Cho
- Cardiovascular Center, Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Suk-Koo Choi
- Cardiovascular Center, Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
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Abstract
PURPOSE OF REVIEW This review updates the relationship between HIV and cardiovascular abnormalities in the context of the pathophysiology of coronary artery disease. RECENT FINDINGS The evaluation of cardiovascular risk in patients with HIV hinges upon a complex interplay of direct and indirect vascular effects of HIV infection, antiretroviral therapy, aging, and exposure to cardiovascular risk factors. Carotid artery intima-media thickness and endothelial-dependent flow-mediated vasodilatation of the brachial artery, which gives an indication of the structural and functional aspect of the endothelium as well as soluble biomarkers, can help to assess the potential harm and benefits of antiretroviral drugs and address the residual burden of cardiovascular risk in the HIV population. SUMMARY Given the complex pathophysiology of cardiovascular disease, no single biomarker is likely to be able to provide a universal surrogate whereby change observed independently predicts benefit, increased risk, or no effect across all drugs and mechanistic targets. Investigations and treatments must be tailored in the single patient according to non-modifiable and modifiable risk factors, including exposure to highly active antiretroviral therapy. With proper risk stratification altering the approach to highly active antiretroviral therapy, lifestyle changes, and lipid-lowering medications are the basis for reducing cardiovascular risk in HIV-infected patients.
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Khunnawat C, Mukerji S, Havlichek D, Touma R, Abela GS. Cardiovascular manifestations in human immunodeficiency virus-infected patients. Am J Cardiol 2008; 102:635-42. [PMID: 18721528 DOI: 10.1016/j.amjcard.2008.04.035] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2008] [Revised: 04/17/2008] [Accepted: 04/17/2008] [Indexed: 10/21/2022]
Abstract
Human immunodeficiency virus (HIV) is now a pandemic. It afflicts multiple organs, including the cardiovascular system. This occurs by direct invasion as well as opportunistic infections complicating acquired immunodeficiency syndrome. The presence of newer highly active antiretroviral therapy has led to longer survival of patients infected with HIV, but the cardiac abnormalities related to HIV have remained less well characterized. It is now evident that cardiac involvement in patients with acquired immunodeficiency syndrome is relatively common. This includes coronary artery disease, dilated cardiomyopathy, pericardial effusion, pulmonary hypertension, and ill effects of highly active antiretroviral therapy in the form of lipodystrophy, lipoatrophy, and dyslipidemia. In fact, HIV can now be viewed as a potential risk factor for coronary artery disease, and the dilemma facing clinicians is how to quantify this risk. Awareness of accelerated coronary artery disease and dilated cardiomyopathy is critical to implement preventive measures early in the course of HIV. However, better guidelines are still needed on the basis of prospective randomized controlled studies involving large populations. In conclusion, this review describes cardiac abnormalities associated with HIV, including possible molecular mechanisms. The co-morbid sequelae, their presentation, and pharmacologic management are also discussed.
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Protease Inhibitor-Induced Hyperlipidemia Treated With Pioglitazone. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2008. [DOI: 10.1097/ipc.0b013e3181461755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Affiliation(s)
- Samuel C Hughes
- Department of Anesthesia and Perioperative Care, San Francisco General Hospital, San Francisco, California 94110, USA.
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Valente AMM, Reis AF, Machado DM, Succi RCM, Chacra AR. [Metabolic alterations in HIV-associated lipodystrophy syndrome]. ACTA ACUST UNITED AC 2006; 49:871-81. [PMID: 16544008 DOI: 10.1590/s0004-27302005000600004] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The introduction of highly active antiretroviral therapy (HAART) has reduced morbidity and mortality in patients infected with the human immunodeficiency virus (HIV). However, prolonged treatment with combination regimens can be difficult to sustain because of problems with adherence and toxic effects. Treatment with antiretroviral agents--protease inhibitors in particular--has uncovered a syndrome of abnormal fat redistribution, impaired glucose metabolism, insulin resistance and dyslipidemia, collectively termed lipodystrophy syndrome (SLHIV). Nowadays, no clinical guidelines are available for the prevention or treatment of SLHIV, and its cause have yet to be totally elucidated. This review emphasizes the clinical features and the data from previous studies about the SLHIV taking into account that a better understanding of this syndrome for HIV specialists, cardiologists and endocrinologists is fundamental for the disease control.
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Affiliation(s)
- Angélica M M Valente
- Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP.
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Neuenburg JK, Furlan S, Bacchetti P, Price RW, Grant RM. Enrichment of activated monocytes in cerebrospinal fluid during antiretroviral therapy. AIDS 2005; 19:1351-9. [PMID: 16103765 DOI: 10.1097/01.aids.0000181008.39514.ee] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES In HIV infection, activated monocytes are enriched in blood and in the perivascular area of the brain, especially in patients with HIV-associated dementia. Although clinical brain disease is uncommon during combination antiretroviral therapy (ART), autopsy series indicate that HIV-infected brain tissue can contain high numbers of monocytes/macrophages despite ART. DESIGN We assessed activated monocytes in blood and cerebrospinal fluid (CSF) in 76 living patients on and off ART. Plasma lipids were measured because they have been associated with monocyte activation and ART. METHODS A novel quantitative six-color flow cytometric approach was used to identify monocytes in blood and CSF and to evaluate monocyte activation status. RESULTS The mean percentage and number of activated CD16 monocytes in CSF was highest in individuals on combination ART, especially in those receiving protease inhibitors (PI). CSF viral load was also associated with higher monocyte activation in CSF. The mean calculated low density lipoprotein (LDL)-, oxidized LDL- and total cholesterol in plasma were highest in patients receiving PI. CONCLUSIONS Activated monocytes are enriched in the CSF of persons living with HIV-1 and receiving ART. This finding is consistent with previously reported autopsy series. The mechanisms and long-term clinical consequences of persistent monocyte activation require further study.
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Affiliation(s)
- Jutta K Neuenburg
- Gladstone Institute of Virology and Immunology, University of California, San Francisco, California 94158, USA.
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Abstract
As combination antiretroviral therapy improves outcome for HIV-infected patients, more focus is directed on the durability of these regimens and the prevention of long-term adverse events. Given the prevalence of metabolic complications associated with combination therapy, namely insulin resistance, dyslipidemia, and truncal adiposity, interest in whether these complications predispose patients to cardiovascular disease prematurely is appropriate. This paper reviews the most recent data regarding the effects of HIV and its treatment on endothelial dysfunction, serum biomarkers, and vascular indices, and provides an update on the risk for cardiovascular events in the HIV-infected patient population.
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Affiliation(s)
- Michelle S Cespedes
- New York University, AIDS Clinical Trial Unit, 550 First Avenue, C & D Building, Room 558, New York, NY 10016, USA.
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Abstract
Human immunodeficiency virus [HIV disease or acquired immunodeficiency syndrome (AIDS)] is the greatest health crisis of the twentieth and early twenty-first century. In sub-Saharan Africa, the epidemic rivals the "Black Death" of fourteenth-century Europe. AIDS is a multiorgan disease that has broad implications for anesthesiologists. New drug therapies are highly effective in most cases and have significant potential for drug interactions. The purpose of this article is to help anesthesiologists better manage persons who have HIV/AIDS in the operating room, labor and delivery suite, and other areas in which this patient population will require an increasing amount of care.
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Affiliation(s)
- Samuel C Hughes
- Department of Anesthesia and Perioperative Care, University of California-San Francisco, San Francisco, CA, USA.
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Pai RK, Kedia A, Hsu PYF, Osborn LA, Taylor RA. AIDS Associated With Severe Cor Pulmonale and Large Pericardial Effusion With Cardiac Tamponade. Cardiol Rev 2004; 12:49-55. [PMID: 14667265 DOI: 10.1097/01.crd.0000089950.17031.42] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Cardiac involvement in patients with advanced HIV/AIDS is common, including pericardial effusion and pulmonary hypertension. Although there is an increased incidence of pericardial effusion in patients with AIDS, most are small and asymptomatic. The presence of a pericardial effusion and/or pulmonary hypertension is associated with shortened survival. We present a case of a 43-year-old man with AIDS and advanced cardiovascular involvement who developed severe cor pulmonale and a large pericardial effusion with cardiac tamponade.
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Affiliation(s)
- Rakesh K Pai
- Department of Internal Medicine, Division of Cardiology University of New Mexico Health Sciences Center, Albuquerque, New Mexico 87131, USA.
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