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Roman S, Mekheal N, Tal S, Michael P. More Than Just an Ulcer: A Case of HIV-Associated Iliac Aneurysms Presenting With a Leg Ulcer. Cureus 2021; 13:e13203. [PMID: 33717743 PMCID: PMC7943397 DOI: 10.7759/cureus.13203] [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] [Indexed: 11/05/2022] Open
Abstract
The incidence of symptomatic vasculitis in human immunodeficiency virus (HIV)-infected patients is approximately 1%, and it commonly presents as arterial occlusive disease or aneurysmal disease. Early diagnosis of vascular complications in those patients is essential; however, it is extremely challenging. Iliac aneurysms are usually silent, and because of their deep location, detection of these aneurysms is typically difficult. Therefore, they always continue to be asymptomatic until rupture unless they are discovered incidentally on a radiological investigation for an irrelative condition. We present the case of a 61-year-old HIV-positive man with bilateral iliac aneurysms and total coronary artery occlusion presenting with a leg ulcer.
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Affiliation(s)
- Sherif Roman
- Internal Medicine, St. Joseph's Regional Medical Center, Paterson, USA
| | - Nader Mekheal
- Internal Medicine, St. Joseph's Regional Medical Center, Paterson, USA
| | - Shani Tal
- Internal Medicine, St. Joseph's Regional Medical Center, Paterson, USA
| | - Patrick Michael
- Internal Medicine, St. Joseph's Univeristy Medical Center, Paterson, USA
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2
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Msoka TF, Van Guilder GP, van Furth M, Smulders Y, Meek SJ, Bartlett JA, Vissoci JRN, van Agtmael MA. The effect of HIV infection, antiretroviral therapy on carotid intima-media thickness: A systematic review and meta-analysis. Life Sci 2019; 235:116851. [PMID: 31499070 PMCID: PMC10496646 DOI: 10.1016/j.lfs.2019.116851] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 09/05/2019] [Accepted: 09/05/2019] [Indexed: 01/09/2023]
Abstract
AIMS We performed a systematic review and meta-analysis on the effect of HIV infection and antiretroviral therapy (ART) on carotid intima-media thickness (cIMT) to elucidate the role of HIV infection and ART. Also, an analysis on the role of ethnicity and gender on cIMT in HIV-infected populations was performed. MAIN METHODS We searched the PubMed, Web of Science, the WHO websites and International AIDS Society for published observational studies were conducted by two independent reviewers for studies comparing HIV-infected antiretroviral-experienced patients and/or inexperienced with healthy controls on cIMT. The primary outcome was the standardized mean difference (SMD) of cIMT. FINDINGS Twenty studies (five cohort, 15 cross-sectional, and two both cohort and cross-sectional studies) were identified comprising 7948 subjects (4656 HIV-infected; 3292 controls). In cohort studies, the standardized mean 1-year change in cIMT between HIV-infected patients and uninfected controls was not significantly different (0.16 mm/yr; 95% CI, -0.16, 0.49; p = 0.326). In 17 cross-sectional studies, the SMD in cIMT was significantly higher in HIV-infected than uninfected persons (0.27 mm; 95% CI, 0.04, 0.49; p = 0.027). HIV-infected patients on ART exhibited significantly higher SMD in cIMT compared to those not on ART (0.75 mm; 95% CI, 0.30, 1.19; p = 0.001). No confounding effect of gender and ethnicity could be established using meta-regression p > 0.05. SIGNIFICANCE HIV infection itself and ART appear to influence the progression of cIMT and hence may be risk factors for cardiovascular events. No firm conclusions could be drawn on the effect of ethnic/race and gender differences on cIMT in HIV-infected populations.
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Affiliation(s)
- Titus F Msoka
- Kilimanjaro Christian Medical Centre, Department of Internal Medicine, Moshi, Tanzania.
| | - Gary P Van Guilder
- Department of Health and Nutritional Sciences, South Dakota State University, USA
| | | | - Yvo Smulders
- VUmc Hospital Amsterdam, Department Infectiology, Netherlands
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3
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Rezer JFP, Adefegha SA, Ecker A, Passos DF, Saccol RSP, Bertoldo TMD, Leal DBR. Changes in inflammatory/cardiac markers of HIV positive patients. Microb Pathog 2017; 114:264-268. [PMID: 29191707 DOI: 10.1016/j.micpath.2017.11.045] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Revised: 11/10/2017] [Accepted: 11/24/2017] [Indexed: 02/07/2023]
Abstract
HIV replication promotes atherogenesis and participates in the immune response to the virus, thereby influencing the inflammatory profile. These changes may, in turn, contribute to the risk of cardiovascular diseases with involvement of platelets. However, adenine nucleotides and nucleosides involved in thromboregulation and modulation of immune response may therefore be affected by these alterations. OBJECTIVES This study sought to evaluate the profile of pro and anti-inflammatory cytokines (IL-10, IL-6, IL-17, TNF, IL-4, IL-2 and IFN-gamma), cardiac markers (troponin, CK, CK MB, LDH, CRP) in HIV-positive patients and assess the in vitro effect of antiretroviral therapy on the activities of ectonucleotidases (E-NTPDase and E-5'-nucleotidase) in human platelets. DESIGN AND METHODS Blood samples were obtained from ten HIV positive patients at the Infectious Disease Clinic of the University Hospital of Santa Maria, Brazil and ten HIV negative individuals (control group) for this study. RESULTS The results revealed that there were significant (P < 0.05) increases in serum levels of IL-6 and IFN-gamma with no significant (P > 0.05) changes in the serum levels of the cardiac markers investigated (CK, CK-MB, troponin, LDH and CRP). In addition, the ectonucleotidases (E-NTPDase and E-5'-nucleotidase) activities were not altered (P > 0.05) in human platelets when incubated with different antiretroviral drugs in vitro. CONCLUSIONS The results of this study suggest that, despite successful treatment, a proinflammatory state is not altered in HIV patients, and that antiretroviral therapy per se does not change the purinergic profile.
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Affiliation(s)
- João F P Rezer
- Programa de Pós-graduação em Ciências Farmacêuticas, Centro de Ciências da Saúde, Universidade Federal de Santa Maria, Av. Roraima, 97105-900, Santa Maria, RS, Brazil
| | - Stephen A Adefegha
- Programa de Pós- graduação em Bioquímica Toxicológica, Centro de Ciências Naturais e Exatas, Universidade Federal de Santa Maria, Av. Roraima, 97105-900, Santa Maria, RS, Brazil
| | - Assis Ecker
- Programa de Pós- graduação em Bioquímica Toxicológica, Centro de Ciências Naturais e Exatas, Universidade Federal de Santa Maria, Av. Roraima, 97105-900, Santa Maria, RS, Brazil
| | - Daniela F Passos
- Programa de Pós- graduação em Bioquímica Toxicológica, Centro de Ciências Naturais e Exatas, Universidade Federal de Santa Maria, Av. Roraima, 97105-900, Santa Maria, RS, Brazil
| | - Renata S P Saccol
- Programa de Pós-graduação em Ciências Farmacêuticas, Centro de Ciências da Saúde, Universidade Federal de Santa Maria, Av. Roraima, 97105-900, Santa Maria, RS, Brazil
| | - Tatiana M D Bertoldo
- Programa de Pós-graduação em Ciências Farmacêuticas, Centro de Ciências da Saúde, Universidade Federal de Santa Maria, Av. Roraima, 97105-900, Santa Maria, RS, Brazil
| | - Daniela B R Leal
- Programa de Pós-graduação em Ciências Farmacêuticas, Centro de Ciências da Saúde, Universidade Federal de Santa Maria, Av. Roraima, 97105-900, Santa Maria, RS, Brazil; Programa de Pós- graduação em Bioquímica Toxicológica, Centro de Ciências Naturais e Exatas, Universidade Federal de Santa Maria, Av. Roraima, 97105-900, Santa Maria, RS, Brazil.
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Conte AH, Esmailian F, LaBounty T, Lubin L, Hardy WD, Yumul R. The patient with the human immunodeficiency virus-1 in the cardiovascular operative setting. J Cardiothorac Vasc Anesth 2012; 27:135-55. [PMID: 22920840 DOI: 10.1053/j.jvca.2012.06.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Indexed: 01/01/2023]
Affiliation(s)
- Antonio Hernandez Conte
- Division of Cardiothoracic Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
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What a differential a virus makes: a practical approach to thoracic imaging findings in the context of HIV infection--part 2, extrapulmonary findings, chronic lung disease, and immune reconstitution syndrome. AJR Am J Roentgenol 2012; 198:1305-12. [PMID: 22623542 DOI: 10.2214/ajr.11.8004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The Centers for Disease Control and Prevention reported more than one million people with HIV infection in the United States in 2006, an increase of 11% over 3 years. Worldwide, nearly 34 million people are infected with HIV. Pulmonary disease accounts for 30-40% of acute hospitalizations of HIV-seropositive patients, underscoring the importance of understanding the range of cardiothoracic imaging findings associated with HIV infection. This article will cover extrapulmonary thoracic diseases, chronic lung diseases, and immune reconstitution inflammatory syndrome in HIV-infected patients. Our approach is focused on the radiologist's perspective by recognizing and categorizing key imaging findings to generate a differential diagnosis. The differential diagnosis can be further refined by incorporating clinical data, such as patient demographics, CD4 count, and presenting symptoms. In addition, with prolonged survival of HIV-infected patients in the era of highly active antiretroviral therapy, radiologists can also benefit from awareness of imaging features of a myriad of chronic cardiopulmonary diseases in this patient population. Finally, the change of imaging findings and clinical status in response to treatment provides important diagnostic information, such as in immune reconstitution syndrome. CONCLUSION Developing a practical approach to key cardiothoracic imaging findings in HIV-infected patients will aid the radiologist in generating a clinically relevant differential diagnosis and interpretation, thereby improving patient care.
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Infective coronary arteritis: a pathological analysis at autopsy. Hum Pathol 2012; 43:2334-41. [PMID: 22832381 DOI: 10.1016/j.humpath.2012.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Revised: 04/08/2012] [Accepted: 04/11/2012] [Indexed: 11/20/2022]
Abstract
Coronary artery disease, one of the leading causes of worldwide adult mortality, is most commonly atherosclerotic in pathogenesis. Nonatherosclerotic etiologies are quite rare. In the latter category, infective arteritis or infective vasculitis of the coronary arteries is a very rare but well-recognized subtype, usually discovered at autopsy. In this article, we present the clinicopathologic necropsy data of 10 patients in whom infective coronary arteritis was the leading cause of death. Among the 10 cases, the male/female ratio was 6:4, and with the exception of a 2-year-old female child, all the other patients were adults with an age range of 26 to 59 years. Of the 10 cases, 6 had infective endocarditis along with history of rheumatic heart disease in 3 patients, whereas 2 other patients had strong clinical suspicion of bacteremia or septicemia. The remaining 2 cases had preexisting coronary atherosclerosis with a history of stent placement in 1 of them. All our cases showed on histopathology acute obliterative inflammatory infiltrate consisting mainly of neutrophils along with bacterial colonies (in most of them) involving the epicardial and intramural coronary arteries. To the best of our knowledge, this is the largest series of infective coronary arteritis to be reported in the world.
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Abstract
Highly active antiretroviral therapy (HAART) significantly changed the prevalence of the cardiovascular manifestations of human immunodeficiency virus (HIV)/AIDS. In developed countries, a 30 per cent reduction in the prevalence of cardiomyopathy and pericardial effusion was observed, possibly related to a reduction of opportunistic infections and myocarditis. In developing countries, however, where the availablity of HAART is limited, and the pathogenic impact of nutritional factors is significant, a 32 per cent increase was seen in the prevalence of cardiomyopathy and related high mortality rate from congestive heart failure. Also, some HAART regimens in developed countries, especially those including protease inhibitors, may cause, in a high proportion of HIV-infected patients, a lipodystrophy syndrome that is associated with an increased risk of cardiovascular events related to a process of accelerated atherosclerosis. Careful cardiac screening is warranted for patients who are being evaluated for, or who are receiving HAART regimens, particularly for those with known underlying cardiovascular risk factors, according to the most recent clinical guidelines.
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Affiliation(s)
- Giuseppe Barbaro
- Department of Medical Pathophysiology, University La Sapienza, Rome, Italy.
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Barbaro G. Heart and HAART: Two sides of the coin for HIV-associated cardiology issues. World J Cardiol 2010; 2:53-7. [PMID: 21160756 PMCID: PMC2999028 DOI: 10.4330/wjc.v2.i3.53] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2010] [Revised: 03/08/2010] [Accepted: 03/15/2010] [Indexed: 02/06/2023] Open
Abstract
The introduction of highly active antiretroviral therapy (HAART) has generated a contrast in the cardiac manifestations of acquired immunodeficiency syndrome. In developed countries, we have observed an approximately 30% reduction in the prevalence of human immunodeficiency virus (HIV)-associated cardiomyopathy, possibly related to a reduction of opportunistic infections and myocarditis. In developing countries, however, where the availablity of HAART is limited and the pathogenic impact of nutritional factors is significant, we have observed an approximately 32% increase in the prevalence of HIV-associated cardiomyopathy and a related high mortality rate from congestive heart failure. Also, some HAART regimens in developed countries, especially those including protease inhibitors, have been shown to cause, in a high proportion of HIV-infected patients, an iatrogenic metabolic syndrome (HIV-lipodystrophy syndrome) that is associated with an increased risk of cardiovascular events related to a process of accelerated atherosclerosis, even in young HIV-infected people. Careful cardiac screening is warranted for patients who are being evaluated for, or who are receiving, HAART regimens, particularly for those with known underlying cardiovascular risk factors. A close collaboration between cardiologists and infectious disease specialists is needed for decisions regarding the use of antiretrovirals, for a careful stratification of cardiovascular risk factors, and for cardiovascular monitoring of HIV-infected patients receiving HAART, according the most recent clinical guidelines.
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Affiliation(s)
- Giuseppe Barbaro
- Giuseppe Barbaro, Cardiology Unit, Department of Medical Pathophysiology, Policlinico Umberto I°, University "La Sapienza", 00174 Rome, Italy
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Jiang J, Fu W, Wang X, Lin PH, Yao Q, Chen C. HIV gp120 induces endothelial dysfunction in tumour necrosis factor-alpha-activated porcine and human endothelial cells. Cardiovasc Res 2010; 87:366-74. [PMID: 20083573 DOI: 10.1093/cvr/cvq013] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
AIMS The aim of this study was to determine direct effects and potential molecular mechanisms of HIV gp120, a viral envelope glycoprotein, on endothelial function. METHODS AND RESULTS Fresh porcine coronary artery rings and human coronary artery endothelial cells (HCAECs) were treated with recombinant HIV gp120 for 16 h with or without pretreatment with tumour necrosis factor-alpha (TNF-alpha) (8 h). With a myograph tension analysis, HIV gp120 with TNF-alpha pretreatment significantly decreased endothelium-dependent vasorelaxation in response to bradykinin in porcine coronary artery rings compared with untreated control vessels. In addition, HIV gp120 with TNF-alpha pretreatment significantly reduced endothelial nitric oxide synthase (eNOS) expression-both mRNA and protein levels-in porcine coronary artery rings and HCAECs compared with untreated controls. Furthermore, TNF-alpha pretreatment substantially increased intercellular adhesion molecule-1 (ICAM-1) expression in artery rings and HCAECs. Anti-gp120 or anti-ICAM-1 antibody significantly blocked these effects of HIV gp120. Silencing of ICAM-1 by siRNA oligonucleotides significantly blocked the effect of gp120 on eNOS downregulation in TNF-alpha-pretreated HCAECs. CONCLUSION HIV gp120 and TNF-alpha synergistically reduce eNOS expression and cause endothelial dysfunction in both porcine coronary arteries and HCAECs. ICAM-1 induced by TNF-alpha pretreatment may mediate HIV gp120-induced endothelial dysfunction, which suggests a novel molecular mechanism of HIV gp120-ICAM-1 interaction inducing endothelial dysfunction.
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Affiliation(s)
- Jun Jiang
- Molecular Surgeon Research Center, Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
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HIV infection and rheumatic diseases: the changing spectrum of clinical enigma. Rheum Dis Clin North Am 2009; 35:139-61. [PMID: 19481002 DOI: 10.1016/j.rdc.2009.03.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
In this article, the authors discuss the occurrence and prevalence of rheumatic syndromes before and after highly active antiretroviral therapy became the usual mode of treatment. The immunologic, environmental, and genetic factors behind the combination of HIV infection and rheumatic manifestation contribute to the complexity of these diseases. Miscellaneous case reports are discussed in relation to HIV infection. The authors conclude that geriatric care of HIV patients is on the horizon as more people have access to newer, more effective therapy and mortality is on the decline. Younger HIV patients will be committed to a lifetime of therapy to address bone disease and other chronic problems. In the future, newer agents may steer the clinical scenario in unforeseen directions.
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Monsuez JJ, Charniot JC, Escaut L, Teicher E, Wyplosz B, Couzigou C, Vignat N, Vittecoq D. HIV-associated vascular diseases: Structural and functional changes, clinical implications. Int J Cardiol 2009; 133:293-306. [DOI: 10.1016/j.ijcard.2008.11.113] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2008] [Revised: 11/04/2008] [Accepted: 11/26/2008] [Indexed: 12/14/2022]
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Sani MU. Myocardial disease in human immunodeficiency virus (HIV) infection: a review. Wien Klin Wochenschr 2008; 120:77-87. [PMID: 18322768 DOI: 10.1007/s00508-008-0935-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2007] [Accepted: 12/28/2007] [Indexed: 10/22/2022]
Abstract
Heart muscle disease is the most important cardiovascular manifestation of HIV infection and is likely to become even more prevalent as HIV infected patients live longer. This may present as myocarditis, dilated cardiomyopathy or isolated left or right ventricular dysfunction. Myocardial involvement in HIV infection is multifactorial and may arise as a result of myocardial invasion with HIV itself, opportunistic infections, viral infections, autoimmune response to viral infection, drug-related cardiac toxicity, nutritional deficiencies, and prolonged immunosuppression. Both adults and children are affected with severity ranging from incidental microscopic inflammatory findings at autopsy to clinically significant cardiac disease with chronic cardiac dysfunction. It is associated with a poor prognosis, and results in symptomatic heart failure in up to 5% of HIV patients. Clinical pathological studies from the pre-HAART era show a 30% prevalence of cardiomyopathy in patients with AIDS. The introduction of highly active antiretroviral therapy (HAART) regimens has substantially modified the course of HIV disease by lengthening survival and improving quality of life of HIV-infected patients. There is also good evidence that HAART significantly reduces the incidence of cardiovascular manifestations of HIV infection. By preventing opportunistic infections and reducing the incidence of myocarditis, HAART regimens have reduced the prevalence of HIV-associated cardiomyopathy by almost 7-fold from the pre-HAART era. HAART is however only available to a minority of HIV infected individuals in most areas of the world and studies from the pre-HAART period still apply. In this review, the aetiopathogenesis and presentation of HIV related myocardial disease were reviewed and measures taken to improve survival discussed.
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Walker UA, Tyndall A, Daikeler T. Rheumatic conditions in human immunodeficiency virus infection. Rheumatology (Oxford) 2008; 47:952-9. [PMID: 18413346 DOI: 10.1093/rheumatology/ken132] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Many rheumatic diseases have been observed in HIV-infected persons. We, therefore, conducted a comprehensive literature search in order to review the prevalence, presentation and pathogenesis of rheumatic manifestations in HIV-infected subjects. Articular conditions (arthralgia, arthritis and SpAs) are either caused by the HIV infection itself, triggered by adaptive changes in the immune system, or secondary to microbial infections. Muscular symptoms may result from rhabdomyolysis, myositis or from side-effects of highly active anti-retroviral therapy (HAART). Osseous complications include osteonecrosis, osteoporosis and osteomyelitis. Some conditions such as the diffuse infiltrative lymphocytosis syndrome and sarcoidosis affect multiple organ systems. SLE may be observed but may be difficult to differentiate from HIV infection. Some anti-retroviral agents can precipitate hyperuricaemia and are associated with arthralgia. When indicated, immunosuppressants and even anti-TNF-alpha agents can be used in the carefully monitored HIV patient. Thus, rheumatic diseases and asymptomatic immune phenomena remain prevalent in HIV-infected persons even after the widespread implementation of highly active anti-retroviral therapy.
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Affiliation(s)
- U A Walker
- Department of Rheumatology, Basel University, Basel, Switzerland.
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Eugenin EA, Morgello S, Klotman ME, Mosoian A, Lento PA, Berman JW, Schecter AD. Human immunodeficiency virus (HIV) infects human arterial smooth muscle cells in vivo and in vitro: implications for the pathogenesis of HIV-mediated vascular disease. THE AMERICAN JOURNAL OF PATHOLOGY 2008; 172:1100-11. [PMID: 18310503 DOI: 10.2353/ajpath.2008.070457] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Human immunodeficiency virus (HIV) infection is associated with accelerated atherosclerosis and vasculopathy, although the mechanisms underlying these findings have not been determined. Hypotheses for these observations include: 1) an increase in the prevalence of established cardiac risk factors observed in HIV-infected individuals who are currently experiencing longer life expectancies; 2) the dyslipidemia reported with certain HIV anti-retroviral therapies; and/or 3) the proinflammatory effects of infiltrating HIV-infected monocytes/macrophages. An unexplored possibility is whether HIV itself can infect vascular smooth muscle cells (SMCs) and, by doing so, whether SMCs can accelerate vascular disease. Our studies demonstrate that human SMCs can be infected with HIV both in vivo and in vitro. The HIV protein p24 was detected by fluorescence confocal microscopy in SMCs from tissue sections of human atherosclerotic plaques obtained from HIV-infected individuals. Human SMCs could also be infected in vitro with HIV by a mechanism dependent on CD4, the chemokine receptors CXCR4 or CCR5, and endocytosis, resulting in a marked increase in SMC secretion of the chemokine CCL2/MCP-1, which has been previously shown to be a critical mediator of atherosclerosis. In addition, SMC proliferation appeared concentric to the vessel lumen, and minimal inflammation was detected, unlike typical atherosclerosis. Our data suggest that direct infection of human arterial SMCs by HIV represents a potential mechanism in a multifactorial paradigm to explain the exacerbated atherosclerosis and vasculopathy reported in individuals infected with HIV.
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Affiliation(s)
- Eliseo A Eugenin
- Department of Pathology, Albert Einstein College of Medicine, Bronx, NY, USA
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Restrepo CS, Diethelm L, Lemos JA, Velásquez E, Ovella TA, Martinez S, Carrillo J, Lemos DF. Cardiovascular complications of human immunodeficiency virus infection. Radiographics 2006; 26:213-31. [PMID: 16418253 DOI: 10.1148/rg.261055058] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The heart and great vessels are not the sites most frequently affected by opportunistic infections and neoplastic processes in patients with acquired immune deficiency syndrome (AIDS). However, cardiovascular complications occur in a significant number of such patients and are the immediate cause of death in some. The spectrum of cardiovascular complications of AIDS that may be depicted at imaging includes dilated cardiomyopathy, pericardial effusion, human immunodeficiency virus-associated pulmonary hypertension, endocarditis, thrombosis, embolism, vasculitis, coronary artery disease, aneurysm, and cardiac involvement in AIDS-related tumors. To aid accurate diagnosis and appropriate treatment planning, radiologists should be familiar with the imaging appearance of each of these complications.
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Affiliation(s)
- Carlos S Restrepo
- Department of Radiology, Louisiana State University Health Sciences Center, 1542 Tulane Ave, Room 212, New Orleans, LA 70112, 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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Boccara F, Ederhy S, Janower S, Benyounes N, Odi G, Cohen A. Clinical characteristics and mid-term prognosis of acute coronary syndrome in HIV-infected patients on antiretroviral therapy. HIV Med 2006; 6:240-4. [PMID: 16011528 DOI: 10.1111/j.1468-1293.2005.00283.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Acute coronary syndromes (ACSs) and coronary artery disease are emerging complications in HIV-infected patients on highly active antiretroviral treatment. The aim of this study was to determine the mid-term prognosis of ACS in HIV-infected patients. METHODS We evaluated the clinical characteristics and follow-up profile [38+/-15 months; mean+/-standard deviation (SD)] of ACS in 20 HIV-infected patients (mean +/-SD: age 44+/-8 years; range 35-65 years). All had coronary angiograms performed mean time 3+/-48 h after the onset of symptoms. RESULTS Eighteen patients were on antiretroviral therapy, of whom 13 patients were on regimens including protease inhibitors (mean duration+/-SD: 19+/-13 months). Fifteen patients had a first episode of ST segment elevation ACS and five had non-ST segment elevation ACS. Tobacco consumption (80%) and hypercholesterolaemia (50%) were the most frequent cardiovascular risk factors. During initial hospitalization, four patients were treated with thrombolysis, two had primary coronary angioplasty and seven had secondary coronary angioplasty. At follow up, 10 patients (50%) had had 18 cardiovascular events: one cardiovascular death, seven episodes of recurrent myocardial ischaemia in four patients, three pulmonary oedemas in two patients, and seven revascularization procedures in five patients. CONCLUSIONS This preliminary report highlights the risk of ACS and related complications in HIV-infected patients and raises questions regarding the implications of antiretroviral treatment.
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Affiliation(s)
- F Boccara
- Service de Cardiologie, Saint-Antoine University and Medical School, Assistance Publique-Hôpitaux de Paris and Université Pierre et Marie Curie (Paris VI), Paris, France
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Abstract
Background—
Human immunodeficiency virus (HIV) infection is the single greatest health challenge facing Africa today. However, the impact of the HIV epidemic on the cardiovascular system in Africans has received scant attention in the world literature.
Methods and Results—
We searched MEDLINE (January 1, 1980, to December 31, 2004) and reference lists of literature on HIV and the heart in Africa and contacted experts in the field. The search for this review yielded 22 articles involving HIV and the cardiovascular system from 8 countries in Africa.
Conclusions—
The available information suggests that there are unique features in the etiology, presentation, and spectrum of HIV-associated cardiovascular disorders in people living in Africa. First, pericardial disease may be the initial manifestation of HIV infection in the early stages of the illness. Second, the etiology of cardiac disease tends to reflect the prevalent infectious diseases, such as tuberculosis. Third, unique cardiovascular disorders such as aneurysm of large vessels have been reported in association with HIV infection in several parts of Africa. Finally, the HIV/AIDS pandemic has put pressure on the meager healthcare resources and fragile infrastructure in many African countries, making the diagnosis and treatment of heart disease unrelated to HIV even more difficult.
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Affiliation(s)
- Mpiko Ntsekhe
- The Cardiac Clinic, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.
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19
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Sevastianova K, Sutinen J, Westerbacka J, Ristola M, Yki-Järvinen H. Arterial Stiffness in HIV-Infected Patients Receiving Highly Active Antiretroviral Therapy. Antivir Ther 2005. [DOI: 10.1177/135965350501000808] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
HIV-infected patients receiving highly active antiretroviral therapy (HAART) are at increased risk of cardiovascular events. Reported non-invasive techniques for assessment of blood pressure in this population have been limited to sphygmomanometry. The present cross-sectional study investigated the impact of antiretroviral therapy and the HAART-associated lipodystrophy on aortic blood pressure conditions and arterial stiffness in HAART-treated lipodystrophic ( n=42) and non-lipodys-trophic ( n=17) patients. Pulse wave analysis, novel to this population, was used to evaluate measures of arterial stiffness, including the heart rate corrected augmentation index, AgIHR. Results indicated no significant difference between the study groups in peripheral or aortic blood pressure and AgIHR. Significant correlates of AgIHR included age ( P=0.003), duration of antiretroviral therapy ( P=0.020), lamivudine therapy ( P=0.015) and ritonavir therapy ( P=0.016) as well as cumulative exposure to protease inhibitors ( P=0.030). Time since HIV diagnosis, severity of immunodeficiency or presence of HAART-associated lipodystrophy bore no relationship to AgIHR. In multivariate analysis, duration of antiretroviral therapy ( P=0.046), cumulative exposure to nucleoside reverse transcriptase inhibitors ( P=0.032) and to protease inhibitors ( P=0.011) were identified as independent factors predicting AgIHR. Prolonged antiretroviral treatment, thus, delineates as a risk factor for systemic arterial stiffness and the associated cardiovascular mortality.
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Affiliation(s)
- Ksenia Sevastianova
- Department of Medicine, Division of Diabetes, Helsinki University Central Hospital, Helsinki, Finland
| | - Jussi Sutinen
- Department of Medicine, Division of Diabetes, Helsinki University Central Hospital, Helsinki, Finland
- Infectious Diseases, Helsinki University Central Hospital, Helsinki, Finland
| | - Jukka Westerbacka
- Department of Medicine, Division of Diabetes, Helsinki University Central Hospital, Helsinki, Finland
| | - Matti Ristola
- Infectious Diseases, Helsinki University Central Hospital, Helsinki, Finland
| | - Hannele Yki-Järvinen
- Department of Medicine, Division of Diabetes, Helsinki University Central Hospital, Helsinki, Finland
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20
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Saporito F, Micari A, Raffa S, Cerrito M, Micari G, Grassi R. Acute myocardial infarction and rescue percutaneous transluminal coronary angioplasty in a young HIV-infected patient. Int J Clin Pract 2005; 59:376-8. [PMID: 15857340 DOI: 10.1111/j.1742-1241.2004.00246.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
We report a case of acute myocardial infarction in an HIV-infected patient without significant coronary artery disease (CAD) risk factors. The patient underwent rescue percutaneous transluminal coronary angioplasty (PTCA), with a successful outcome. We presume a possible pathogenetic role of anti-retroviral therapy and/or direct viral action on ischaemic heart disease progression. We propose that the current approach to management of AIDS-affected patients needs close monitoring for CAD risk factors and symptoms, to improve prognosis and life expectancy.
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Affiliation(s)
- F Saporito
- Department of Clinical and Experimental Medicine and Pharmacology, University of Messina School of Medicine, Messina, Italy.
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21
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Vandhuick O, Guias B, De Saint Martin L, Bressollette L. Traitement antirétroviral et risque cardio-vasculaire. ACTA ACUST UNITED AC 2004; 29:192-9. [PMID: 15529082 DOI: 10.1016/s0398-0499(04)96747-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Current antiretroviral therapy protocols enable long-term survival of HIV-infected patients, decreasing the risk of infectious complications. Three classes of anti-HIV treatments are available. With longer survival, unusual cardiovascular complications related to iatrogenic biological anomalies (dyslipidemia and impaired glucose tolerance) have appeared among this young population which is exposed to usual risk factors of atherosclerosis. Antiretroviral therapies are suspected to cause these complications, inducing maturity-onset diabetes in 4 to 20% of patients, impaired glucose tolerance in 15 to 60%, hypertriglyceridemia in 15 to 74% depending on the survey, and hypercholesterolemia in 20 to 60%, especially in case of associated lipodystrophia. A lipid battery including total cholesterol, HDL, and triglycerides, and 12-h fasting blood glucose should be obtained before initiating antiretroviral therapy. Any anomalous finding should be followed carefully with regular surveillance every 3 to 6 months and search for other causes of secondary dyslipidemia. In the event of casual and persisting elevation of LDL-cholesterol levels, a statin treatment can be introduced. For secondary prevention, irrespective of the context, recommendations currently merge with the consensus applying to the general population. These patients require careful surveillance of cardiovascular risk factors and a specific care in addition to treatment of their immunodeficiency.
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Affiliation(s)
- O Vandhuick
- Unité d'Echo-Doppler et de Médecine Vasculaire, CHU La Cavale Blanche, 29609 Brest
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22
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Escaut L, Monsuez JJ, Chironi G, Merad M, Teicher E, Smadja D, Simon A, Vittecoq D. Coronary artery disease in HIV infected patients. Intensive Care Med 2003; 29:969-973. [PMID: 12739013 DOI: 10.1007/s00134-003-1740-0] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2002] [Accepted: 03/03/2003] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess the incidence, clinical features, treatment, and follow-up of coronary events in HIV-infected patients over a period of 5 years. PATIENTS AND PARTICIPANTS A cohort of 840 patients. MEASUREMENTS AND RESULTS A coronary event occurred in 17 patients (5.9/1000 persons-years). Sixteen of them were exposed to highly active antiretroviral therapy (HAART). Patients with coronary events differed in age (48.3 vs. 43 years), CD4 T-cell count (284 vs. 486/mm(3)), total cholesterol (6.2 vs. 5.3 mmol/l), HDL cholesterol (0.72 vs. 1.16 mmol/l), and LDL cholesterol (4.95 vs. 3.391.61 mmol/l). No difference was observed regarding duration of HAART, weight, glucose level, or smoking status between the two groups. Acute coronary syndrome was the first manifestation in 14 patients. Coronary angiography showed 2.56 stenosis per patient, with a single vessel involvement in one-half. Percutaneous angioplasty was performed in all cases, with stenting in 11. After a mean follow-up of 36 months, 14 patients remain alive. Restenosis ( n=4) occurred in 3 patients (PTCA 3; stenting 4). All 14 patients are free of heart failure symptoms. Their mean left ventricular ejection fraction is 61%. CONCLUSIONS A higher coronary-event rate is observed among HIV-infected patients, associated with drug-induced metabolic disturbances and a high prevalence of tobacco smoking. However, treatment and prognosis of acute myocardial infarction has no specificity.
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Affiliation(s)
- Lelia Escaut
- Service des Maladies Infectieuses, Hôpital Paul Brousse, 12-14 avenue Paul Vaillant Couturier, 94804, Villejuif, France
| | - Jean Jacques Monsuez
- Service des Maladies Infectieuses, Hôpital Paul Brousse, 12-14 avenue Paul Vaillant Couturier, 94804, Villejuif, France
| | - Gilles Chironi
- Service des Maladies Cardiovasculaires, Hôpital Broussais, Paris, France
| | - Mansouriah Merad
- Service des Maladies Infectieuses, Hôpital Paul Brousse, 12-14 avenue Paul Vaillant Couturier, 94804, Villejuif, France
| | - Elina Teicher
- Service des Maladies Infectieuses, Hôpital Paul Brousse, 12-14 avenue Paul Vaillant Couturier, 94804, Villejuif, France
| | - Denis Smadja
- Service des Maladies Infectieuses, Hôpital Paul Brousse, 12-14 avenue Paul Vaillant Couturier, 94804, Villejuif, France
| | - Alain Simon
- Service des Maladies Cardiovasculaires, Hôpital Broussais, Paris, France
| | - Daniel Vittecoq
- Service des Maladies Infectieuses, Hôpital Paul Brousse, 12-14 avenue Paul Vaillant Couturier, 94804, Villejuif, France.
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23
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Abstract
Cases, case series, and related articles on coronary artery disease in patients with human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) identified through a comprehensive literature search were examined for clinical characteristics and angiographic findings of HIV-associated coronary artery disease. Among 129 identified cases, 91% were males. The mean age was 42.3 +/- 10.2 (SD) years (range, 23 to 77 years). The interval between the diagnosis of HIV infection and the diagnosis of coronary artery disease was 72 +/- 60 (SD) months. Degree of immunosuppression was variable (CD4 mean, 313 +/- 209 cells/mm3; range, 6-1070 cells/mm3). There was no correlation between the CD4 cell count and the development and progression of coronary artery disease. Similarly, the development and progression of coronary artery disease was independent of the presence of HIV-related opportunistic infections. Acute myocardial infarction was the initial presentation in 77% of patients. In 76 patients, information on diseased vessels was available: 36 (47%) patients had 3-vessel disease, 14 (18%) patients had 2-vessel disease, and 26 patients (35%) had 1-vessel disease. The left anterior descending artery was involved in 47 (62%) patients while the left circumflex and right coronary arteries were involved in 34 (45%) and 38 (50%) patients, respectively. Thirty-two (25%) patients underwent catheter-based or surgical revascularization. Data were not adequate to assess the prognosis following the acute coronary events or revascularization. The histologic characteristics unique to HIV-associated coronary arteriopathy were diffuse circumferential involvement of the vessel with an unusual proliferation of smooth muscle cells, mixed with abundant elastic fibers, resulting in endoluminal protrusions. Coronary artery disease was a late complication of AIDS.
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Affiliation(s)
- Nirav J Mehta
- Division of Cardiology, Department of Medicine, Creighton University School of Medicine, Omaha, NE, USA
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24
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Clinical and biological insights in HIV-associated cardiovascular disease in the era of highly active antiretroviral therapy. AIDS 2003. [DOI: 10.1097/00002030-200304001-00001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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25
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Johnson RM, Barbarini G, Barbaro G. Kawasaki-like syndromes and other vasculitic syndromes in HIV-infected patients. AIDS 2003; 17 Suppl 1:S77-82. [PMID: 12870534 DOI: 10.1097/00002030-200304001-00011] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Excluding drug-related hypersensitivity reactions, vasculitic syndromes are not common in HIV-positive patients. Review of the existing literature suggests that HIV positive patients may be predisposed to polyarteritis nodosa, microscopic polyarteritis, Kawasaki-like syndromes, acute occlusion syndromes, primary angiitis of the central nervous system and erythema elevatum diutinum. With the exception of erythema elevatum diutinum, these vasculitic syndromes have significant morbidities and mortality if they are not treated. It is therefore important to make these diagnoses and to initiate appropriate therapy in a timely fashion. Because fevers, malaise, weakness, rashes, headaches and neurologic symptoms are common in HIV-positive patients, it is probable that some cases of vasculitis go undiagnosed. In this report, we review vasculitic syndromes seen in HIV-positive patients. We also re-examine a previously published case of a young HIV-positive male who died of an acute myocardial infarction without atherosclerotic disease. Immunohistopathology of the affected arteries suggests that he died of a Kawasaki-like syndrome.
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Affiliation(s)
- Raymond M Johnson
- Division of Infectious Diseases, Indiana School of Medicine, Indianapolis, Indiana 46202, USA.
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26
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Vittecoq D, Escaut L, Chironi G, Teicher E, Monsuez JJ, Andrejak M, Simon A. Coronary heart disease in HIV-infected patients in the highly active antiretroviral treatment era. AIDS 2003; 17 Suppl 1:S70-6. [PMID: 12870533 DOI: 10.1097/00002030-200304001-00010] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To assess the incidence and the clinical features of coronary heart disease in HIV-infected patients. To assess atherosclerosis risk factors in this population. METHODS A review of our experience consisting of 16 patients with acute myocardial infarction (AMI) was the basis of our retrospective analysis of two cohorts in France. Incidence was compared with the national database on the incidence of AMI in the general population. RESULTS Incidence appears to be between 5 and 5.5 per 1000 person-years among HIV-infected patients. This accounts for at least a threefold increase in incidence (1.52 per 1000 person-years reported in the Monica database registry in France). Age of onset of AMI in HIV-infected patients (younger than 50 years in most cases) is a point of major concern and is an indirect way to confirm the increased incidence. AMI was typically of sudden onset without prior history of angina pectoris. Treatment and prognosis of AMI in this population has no specificity. Patients with coronary heart disease present several risk factors such as tobacco smoking, hypertension, diabetes mellitus and low high-density lipoprotein level. The links between AMI and protease inhibitor exposure is still a matter of debate, and longer duration of follow-up is needed in order to reach any conclusion. CONCLUSIONS Coronary heart disease is of a higher than expected incidence in HIV-infected patients. The limitation of risk factors (mainly tobacco smoking) is a new challenge. An adaptation of the Framingham score is necessary to state the individual risk. Prospective, controlled studies are necessary to assess new strategies such as the role of statins and switching therapeutic regimens.
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Affiliation(s)
- Daniel Vittecoq
- Service des Maladies Infectieuses et de Médecine Interne, Hôpital Paul Brousse, Villejuif, France.
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27
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Abstract
The heart is an organ frequently affected in patients with acquired immune deficiency syndrome (AIDS). Since the introduction of highly active antiretroviral therapy (HAART), a sharp decline in mortality and morbidity has been observed in human immunodeficiency virus (HIV)-infected patients. However, numerous reports of myocardial infarcts in young HIV-infected patients have raised concerns of premature coronary artery disease in this population. New risk factors for coronary heart disease such as increased insulin resistance, dyslipidemia, and lipodystrophy syndrome, which are associated with HAART, may accelerate underlying arteriosclerosis in HIV-infected patients. Data on the incidence of coronary heart disease are limited to case reports and retrospective studies. Results from ongoing, large, prospective studies will provide information on whether or not HAART may increase the incidence of myocardial infarcts and whether a drastic change in HIV therapy is warranted.
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Affiliation(s)
- Bruno R Cotter
- University of California, San Diego, Division of Cardiology, UCSD Medical Center, San Diego, CA 92103-8411, USA.
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28
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Abstract
The association of immune dysfunction in patients with human immunodeficiency virus (HIV) infection and AIDS and the development of autoimmune diseases is intriguing. Yet, the spectrum of reported autoimmune phenomena in these patients is increasing. An infectious trigger for immune activation is one of the postulated mechanisms and derives from molecular mimicry. During frank loss of immunocompetence, autoimmune diseases that are predominantly T cell subtype CD8 driven predominate. There is evidence for B cell stimulation and many autoantibodies are reported in HIV patients. We propose a staging of autoimmune manifestations related to HIV/AIDS manifestations and the total CD4 count and viral load that may be beneficial in identifying the type of autoimmune disease and establishing the proper therapy. In stage I there is the acute HIV infection, and the immune system is intact. In this stage, autoimmune diseases may develop. Stage II describes the quiescent period without overt manifestations of AIDS. However, there is a declining CD4 count indicative of some immunosuppression. Autoimmune diseases are not found. During stage III there is immunosuppression with a low CD4 count and the development of AIDS. CD8 T cells predominant and diseases such as psoriasis and diffuse immune lymphocytic syndrome (similar to Sjogren's syndrome) may present or even be the initial manifestation of AIDS. Also during this stage no autoimmune diseases are found. In stage IV there is restoration of immune competence following highly active anti-retroviral therapy (HAART). In this setting, there is a resurgence of autoimmune diseases. The frequency of reported rheumatological syndromes in HIV-infected patients ranges from 1 to 60%. The list of reported autoimmune diseases in HIV/AIDS include systemic lupus erythematosus, anti-phospholipid syndrome, vasculitis, primary biliary cirrhosis, polymyosits, Graves' disease, and idiopathic thrombocytopenic purpura. Also, there is an array of autoantibodies reported in HIV/AIDS patients which include anti-cardiolipin, anti-beta2 GPI, anti-DNA, anti-small nuclear ribonucleoproteins (snRNP), anti-thyroglobulin, anti-thyroid peroxidase, anti-myosin, and anti-erythropoietin antibodies. The association of autoantibodies in HIV-infected patients to clinical autoimmune disease is yet to be established. With the upsurge of HAART, the incidence of autoimmune diseases in HIV-infected patients is increasing. In this review, we describe the various autoimmune diseases that develop in HIV/AIDS patients through possible mechanisms related to immune activation.
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Affiliation(s)
- Gisele Zandman-Goddard
- Center for Autoimmune Diseases, Department of Medicine 'B', Sheba Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Hashomer 52621, Israel
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29
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Affiliation(s)
- Giuseppe Barbaro
- Department of Medical Pathophysiology, University La Sapienza, Rome, Italy.
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30
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Klein D, Hurley LB, Quesenberry CP, Sidney S. Do protease inhibitors increase the risk for coronary heart disease in patients with HIV-1 infection? J Acquir Immune Defic Syndr 2002; 30:471-7. [PMID: 12154337 DOI: 10.1097/00126334-200208150-00002] [Citation(s) in RCA: 314] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
There is continued concern about protease inhibitors (PIs) causing increased risk of coronary heart disease (CHD) in HIV-infected patients. This ongoing observational study examines CHD and myocardial infarction (MI) hospitalization rates among HIV-positive members of the Kaiser Permanente Medical Care Program of Northern California, before and after PI use, and before and after any antiretroviral therapy (ART). Also, CHD and MI hospitalization rates among HIV-infected members are compared with members not known to be HIV-positive. With 4.1 years' median total follow-up, age-adjusted CHD and MI hospitalization rates were not significantly different before versus after PIs (6.2 vs. 6.7 events per 1000 person-years); or before versus after ART (5.7 vs. 6.8). However, comparing HIV-positive and -negative members, the CHD hospitalization rate was significantly higher (6.5 vs. 3.8, p =.003), and the difference in the MI rate also was higher (4.3 vs. 2.9, p =.07). Differences between HIV-positive and -negative members in the CHD risk factors measured were mixed, and the overall clinical significance of these differences is uncertain. Our data suggest that PIs and other antiretroviral therapies do not yet increase CHD or MI hospitalizations among HIV-infected individuals; however, longer follow-up is needed. Other HIV-related mechanisms may be at work, causing increased CHD and MI risk among all HIV-infected persons.
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Affiliation(s)
- Daniel Klein
- Kaiser Permanente Medical Center, Hayward, California, USA.
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31
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Córdoba lópez A, Bueno álvarez-arenas M, Monterrubio villar J, Corcho sánchez G. Infección por virus de la inmunodeficiencia humana y síndrome coronario agudo. Med Intensiva 2002. [DOI: 10.1016/s0210-5691(02)79765-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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32
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Barbaro G, Fisher SD, Lipshultz SE. Pathogenesis of HIV-associated cardiovascular complications. THE LANCET. INFECTIOUS DISEASES 2001; 1:115-24. [PMID: 11871462 DOI: 10.1016/s1473-3099(01)00067-6] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Reviews and studies published before the introduction of highly active antiretroviral therapy (HAART) have tracked the incidence and course of HIV infection in relation to cardiac illness in both children and adults. The introduction of HAART regimens has significantly modified the course of HIV disease, with longer survival rates and improvement of life quality in HIV-infected people expected. However, early data raised concerns about HAART being associated with an increase in both peripheral and coronary arterial diseases. In this review we discuss HIV-associated cardiovascular complications focusing on pathogenetic mechanisms that could have a role in diagnosis, management, and therapy of these complications in the HAART era.
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Affiliation(s)
- G Barbaro
- Department of Emergency Medicine, University La Sapienza, Rome, Italy.
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