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Valenzuela-Rodríguez G. [Cardiovascular compromise in the infection by the human immunodeficiency virus]. ARCHIVOS PERUANOS DE CARDIOLOGIA Y CIRUGIA CARDIOVASCULAR 2023; 4:21-29. [PMID: 37408781 PMCID: PMC10318990 DOI: 10.47487/apcyccv.v4i1.269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 03/15/2023] [Indexed: 07/07/2023]
Abstract
Human immunodeficiency virus (HIV) infection was associated with increased morbidity and mortality, predominantly for opportunistic infections, before using antiretroviral therapy. With this, patients have experienced increased survival and cardiovascular compromise too. The etiology of these clinical conditions could be related to the infection itself, adverse events associated with antiretroviral therapy, or adverse events produced by the combination with other drugs. Some of these conditions have an acute onset, and their rapid recognition is vital for a better prognosis.
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Affiliation(s)
- Germán Valenzuela-Rodríguez
- Clínica Delgado-AUNA, Lima, Perú.Clínica Delgado-AUNALimaPerú
- Unidad de Revisiones Sistemáticas y Metaanálisis (URSIGET), Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima, Perú.Universidad San Ignacio de Loyolanidad de Revisiones Sistemáticas y Metaanálisis (URSIGET)Vicerrectorado de InvestigaciónUniversidad San Ignacio de LoyolaLimaPeru
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2
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Hester EK, Caulder CR, Penzak SR. Impact of team‐based care on appropriate statin therapy prescribing in ***HIV‐infected patients. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2020. [DOI: 10.1002/jac5.1206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Elizabeth K. Hester
- Department of Pharmacy Practice Auburn University Harrison School of Pharmacy Auburn Alabama
| | - Celeste R. Caulder
- Department of Clinical Pharmacy and Outcomes Sciences University of South Carolina College of Pharmacy Columbia South Carolina
| | - Scott R. Penzak
- Department of Pharmacy Practice Auburn University Harrison School of Pharmacy Auburn Alabama
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Phan BAP, Ma Y, Scherzer R, Deeks SG, Hsue PY. Association between statin use, atherosclerosis, and mortality in HIV-infected adults. PLoS One 2020; 15:e0232636. [PMID: 32353062 PMCID: PMC7192415 DOI: 10.1371/journal.pone.0232636] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 04/17/2020] [Indexed: 11/18/2022] Open
Abstract
Background While HIV infection is associated with increased cardiovascular risk, benefit from statin is not well established in HIV-infected adults. We assessed whether statins are associated with a decrease in carotid artery intima-media thickness (cIMT) progression and all-cause mortality in HIV-infected adults who are at elevated ASCVD risk and recommended for statins. Methods Carotid IMT was measured at baseline and follow-up in 127 HIV-infected adults who meet ACC/AHA criteria to be on statins. Inverse probability of treatment weighting (IPTW) was used to address selection bias. Multivariable models were used to control for baseline characteristics. Results 28 subjects (22%) were on statins and 99 subjects (78%) were not. Mean cIMT at baseline was 1.2 mm (SD = 0.34) in statin users and 1.1 mm (SD = 0.34) in non-users, and the multivariable adjusted difference was 0.05mm (95%CI -0.11, 0.21 p = 0.53). After 3.2 years of follow-up, average cIMT progression was similar in statin users and non-users (0.062mm/yr vs. 0.058 mm/yr) and the multivariable adjusted difference over the study period was 0.004 mm/yr (95% CI -0.018, 0.025, p = 0.74). All-cause mortality appeared higher in non-statin users compared with statin users, but the difference was not significant (adjusted HR = 0.74, 95%CI 0.17–3.29, p = 0.70). Conclusion In a HIV cohort who had elevated ASCVD risk and meet ACC/AHA criteria for statins, treatment with statins was not associated with a reduction in carotid atherosclerosis progression or total mortality. Future studies are needed to further explore the impact of statins on cardiovascular risk in the HIV-infected population.
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Affiliation(s)
- Binh An P. Phan
- Division of Cardiology, San Francisco General Hospital, Department of Medicine, University of California, San Francisco, California, United States of America
- * E-mail:
| | - Yifei Ma
- Division of Cardiology, San Francisco General Hospital, Department of Medicine, University of California, San Francisco, California, United States of America
| | - Rebecca Scherzer
- San Francisco Veteran’s Affairs Medical Center and Department of Medicine, University of California, San Francisco, California, United States of America
| | - Steven G. Deeks
- Positive Health Program, San Francisco General Hospital, University of California, San Francisco, California, United States of America
| | - Priscilla Y. Hsue
- Division of Cardiology, San Francisco General Hospital, Department of Medicine, University of California, San Francisco, California, United States of America
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Manafe N, Matimbe RN, Daniel J, Lecour S, Sliwa K, Mocumbi AO. Hypertension in a resource-limited setting: Poor Outcomes on Short-term Follow-up in an Urban Hospital in Maputo, Mozambique. J Clin Hypertens (Greenwich) 2019; 21:1831-1840. [PMID: 31769184 PMCID: PMC8030297 DOI: 10.1111/jch.13732] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 10/16/2019] [Accepted: 10/23/2019] [Indexed: 11/29/2022]
Abstract
Mozambique has low levels of detection, treatment, and control of hypertension. However, data on target organ damage and clinical outcomes are lacking. The authors aimed at characterizing the clinical profile, pattern of target organ damage, and short-term outcomes of patients referred to a first referral urban hospital in a low-income setting in Africa. We conducted a prospective descriptive cohort study from February 2016 to May 2017 in Maputo, Mozambique. Adult patients with systolic and diastolic blood pressure ≥180 mm Hg and/or ≥110 mm Hg, respectively, or any systolic blood pressure above 140 mm Hg and/or diastolic blood pressure above 90 mm Hg in the presence of target organ damage (with or without antihypertensive treatment) were submitted to detailed physical examination, funduscopy, laboratory profile, electrocardiography, and echocardiography. Six months after the occurrence of complications (stroke, heart failure, and renal failure), hospital admission and death were assessed. Overall, 116 hypertensive patients were recruited (mean age 57.5 ± 12.8 years old; 111[95.7%] black; 81[70%] female) of which 79 had severe hypertension. The baseline mean values recorded for systolic and diastolic blood pressure were 192.3 ± 23.6 and 104.2 ± 15.2 mm Hg, respectively. Most patients (93; 80.2%) were on antihypertensive treatment. Patients' risk profile revealed dyslipidemia, obesity, and diabetes in 59(54.1%), 48(42.5%), and 23(19.8%), respectively. Target organ damage was found in 111 patients. The commonest being left atrial enlargement 91(84.5%), left ventricular hypertrophy 57(50.4%), hypertensive retinopathy 30(26.3%), and chronic kidney disease 27(23.3%). Major events during 6-month follow-up were hospitalizations in 10.3% and death in 8.6% of the patients. Worsening of target organ damage occurred in 10 patients: four stroke, two heart failure, and four renal damage. Patients with severe hypertension and target organ damage were young with high-risk profile, low hypertension control, and high occurrence of complications during short-term follow-up. Efforts to improve high blood pressure control are needed to reduce premature mortality in this highly endemic poor setting.
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Affiliation(s)
- Naisa Manafe
- Instituto Nacional de SaudeMaputoMozambique
- Department of Medicine and CardiologyFaculty of Health SciencesUniversity of Cape TownCape TownSouth Africa
| | | | | | - Sandrine Lecour
- Department of Medicine and CardiologyFaculty of Health SciencesUniversity of Cape TownCape TownSouth Africa
| | - Karen Sliwa
- Department of Medicine and CardiologyFaculty of Health SciencesUniversity of Cape TownCape TownSouth Africa
| | - Ana Olga Mocumbi
- Instituto Nacional de SaudeMaputoMozambique
- Universidade Eduardo MondlaneMaputoMozambique
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Salmazo PS, Bazan SGZ, Shiraishi FG, Bazan R, Okoshi K, Hueb JC. Frequency of Subclinical Atherosclerosis in Brazilian HIV-Infected Patients. Arq Bras Cardiol 2018; 110:402-410. [PMID: 29641646 PMCID: PMC5967130 DOI: 10.5935/abc.20180058] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Accepted: 12/12/2017] [Indexed: 12/28/2022] Open
Abstract
Background AIDS as well as atherosclerosis are important public health problems. The
longer survival among HIV-infected is associated with increased number of
cardiovascular events in this population, and this association is not fully
understood. Objectives To identify the frequency of subclinical atherosclerosis in HIV-infected
patients compared to control subjects; to analyze associations between
atherosclerosis and clinical and laboratory variables, cardiovascular risk
factors, and the Framingham coronary heart disease risk score (FCRS). Methods Prospective cross-sectional case-control study assessing the presence of
subclinical atherosclerosis in 264 HIV-infected patients and 279 controls.
Clinical evaluation included ultrasound examination of the carotid arteries,
arterial stiffness by pulse wave velocity (PWV) and augmentation index
(AIx), laboratory analysis of peripheral blood, and cardiovascular risk
according to FCRS criteria. The significance level adopted in the
statistical analysis was p < 0.05. Results Plaques were found in 37% of the HIV group and 4% of controls (p < 0.001).
Furthermore, carotid intima-media thickness was higher in the HIV group than
in controls (p < 0.001). Patients with carotid plaque had higher fasting
glucose, total cholesterol, low-density lipoprotein cholesterol, and
triglycerides than those without plaques. The presence of HIV, adjusted for
age, overweight/obesity, and smoking increased by almost fivefold the risk
of atherosclerotic carotid plaque (OR: 4.9; 95%CI: 2.5-9.9; p < 0.001).
Exposure to protease inhibitors did not influence carotid intima-media
thickness, was not associated with carotid plaque frequency, and did not
alter the mechanical characteristics of the arterial system (PWV and
AIx). Conclusions HIV-infected patients are at increased risk of atherosclerosis in association
with classical cardiovascular risk factors. Treatment with protease
inhibitors does not promote functional changes in the arteries, and shows no
association with increased frequency of atherosclerotic plaques in carotid
arteries. The FCRS may be inappropriate for this population.
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Affiliation(s)
| | | | | | - Rodrigo Bazan
- Faculdade de Medicina de Botucatu (UNESP), Botucatu, SP - Brazil
| | - Katashi Okoshi
- Faculdade de Medicina de Botucatu (UNESP), Botucatu, SP - Brazil
| | - João Carlos Hueb
- Faculdade de Medicina de Botucatu (UNESP), Botucatu, SP - Brazil
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Carvalho AS, Osório Valente R, Almeida Morais L, Modas Daniel P, Sá Carvalho R, Ferreira L, Cruz Ferreira R. HIV and coronary disease - When secondary prevention is insufficient. Rev Port Cardiol 2017; 36:569.e1-569.e8. [PMID: 28697899 DOI: 10.1016/j.repc.2016.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 07/15/2016] [Accepted: 10/03/2016] [Indexed: 10/19/2022] Open
Abstract
Highly active antiretroviral therapy (HAART) has created a new paradigm for human immunodeficiency virus (HIV)-infected patients, but their increased risk for coronary disease is well documented. We present the case of a 57-year-old man, co-infected with HIV-2 and hepatitis B virus, adequately controlled and with insulin-treated type 2 diabetes and dyslipidemia, who was admitted with non-ST elevation acute myocardial infarction. Coronary angiography performed on day four of hospital stay documented two-vessel disease (mid segment of the right coronary artery [RCA, 90% stenosis] and the first marginal). Two drug-eluting stents were successfully implanted. The patient was discharged under dual antiplatelet therapy (aspirin 100 mg/day and clopidogrel 75 mg/day) and standard coronary artery disease medication. He was admitted to the emergency room four hours after discharge with chest pain radiating to the left arm and inferior ST-segment elevation myocardial infarction was diagnosed. Coronary angiography was performed within one hour and documented thrombosis of both stents. Optical coherence tomography revealed good apposition of the stent in the RCA, with intrastent thrombus. Angioplasty was performed, with a good outcome. The acute stent thrombosis might be explained by the thrombotic potential of HIV infection and diabetes. There are no specific guidelines regarding HAART in secondary prevention of acute coronary syndromes. A multidisciplinary approach is essential for optimal management of these patients.
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Affiliation(s)
- Ana Sofia Carvalho
- Serviço de Medicina Interna, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal.
| | | | - Luís Almeida Morais
- Serviço de Cardiologia, Hospital de Santa Marta, Centro Hospitalar Lisboa Central, Lisboa, Portugal
| | - Pedro Modas Daniel
- Serviço de Cardiologia, Hospital de Santa Marta, Centro Hospitalar Lisboa Central, Lisboa, Portugal
| | - Ramiro Sá Carvalho
- Serviço de Cardiologia, Hospital de Santa Marta, Centro Hospitalar Lisboa Central, Lisboa, Portugal
| | - Lurdes Ferreira
- Serviço de Cardiologia, Hospital de Santa Marta, Centro Hospitalar Lisboa Central, Lisboa, Portugal
| | - Rui Cruz Ferreira
- Serviço de Cardiologia, Hospital de Santa Marta, Centro Hospitalar Lisboa Central, Lisboa, Portugal
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Phan BAP, Weigel B, Ma Y, Scherzer R, Li D, Hur S, Kalapus SC, Deeks S, Hsue P. Utility of 2013 American College of Cardiology/American Heart Association Cholesterol Guidelines in HIV-Infected Adults With Carotid Atherosclerosis. Circ Cardiovasc Imaging 2017; 10:e005995. [PMID: 28674084 PMCID: PMC5516666 DOI: 10.1161/circimaging.116.005995] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 05/19/2017] [Indexed: 01/18/2023]
Abstract
BACKGROUND Although HIV is associated with increased atherosclerotic cardiovascular disease (CVD) risk, it is unknown whether guidelines can identify HIV-infected adults who may benefit from statins. We compared the 2013 American College of Cardiology/American Heart Association and 2004 Adult Treatment Panel III recommendations in HIV-infected adults and evaluated associations with carotid artery intima-media thickness and plaque. METHODS AND RESULTS Carotid artery intima-media thickness was measured at baseline and 3 years later in 352 HIV-infected adults without clinical atherosclerotic CVD and not on statins. Plaque was defined as IMT >1.5 mm in any segment. At baseline, the median age was 43 (interquartile range, 39-49), 85% were men, 74% were on antiretroviral medication, and 50% had plaque. The American College of Cardiology/American Heart Association guidelines were more likely to recommend statins compared with the Adult Treatment Panel III guidelines, both overall (26% versus 14%; P<0.001), in those with plaque (32% versus 17%; P=0.0002), and in those without plaque (16% versus 7%; P=0.025). In multivariable analysis, older age, higher low-density lipoprotein cholesterol, pack per year of smoking, and history of opportunistic infection were associated with baseline plaque. Baseline IMT (hazard ratio, 1.18 per 10% increment; 95% confidence interval, 1.05-1.33; P=0.005) and plaque (hazard ratio, 2.06; 95% confidence interval, 1.02-4.08; P=0.037) were each associated with all-cause mortality, independent of traditional CVD risk factors. CONCLUSIONS Although the American College of Cardiology/American Heart Association guidelines recommended statins to a greater number of HIV-infected adults compared with the Adult Treatment Panel III guidelines, both failed to recommend therapy in the majority of HIV-affected adults with carotid plaque. Baseline carotid atherosclerosis but not atherosclerotic CVD risk scores was an independent predictor of mortality. HIV-specific guidelines that include detection of subclinical atherosclerosis may help to identify HIV-infected adults who are at increased atherosclerotic CVD risk and may be considered for statins.
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Affiliation(s)
- Binh An P Phan
- From the Division of Cardiology, Department of Medicine (B.A.P.P., B.W., Y.M., D.L., S.H., S.C.K., P.H.), Positive Health Program (S.D.), San Francisco General Hospital, University of California; and Department of Medicine, San Francisco Veteran's Affairs Medical Center, University of California (R.S.)
| | - Bernard Weigel
- From the Division of Cardiology, Department of Medicine (B.A.P.P., B.W., Y.M., D.L., S.H., S.C.K., P.H.), Positive Health Program (S.D.), San Francisco General Hospital, University of California; and Department of Medicine, San Francisco Veteran's Affairs Medical Center, University of California (R.S.)
| | - Yifei Ma
- From the Division of Cardiology, Department of Medicine (B.A.P.P., B.W., Y.M., D.L., S.H., S.C.K., P.H.), Positive Health Program (S.D.), San Francisco General Hospital, University of California; and Department of Medicine, San Francisco Veteran's Affairs Medical Center, University of California (R.S.)
| | - Rebecca Scherzer
- From the Division of Cardiology, Department of Medicine (B.A.P.P., B.W., Y.M., D.L., S.H., S.C.K., P.H.), Positive Health Program (S.D.), San Francisco General Hospital, University of California; and Department of Medicine, San Francisco Veteran's Affairs Medical Center, University of California (R.S.)
| | - Danny Li
- From the Division of Cardiology, Department of Medicine (B.A.P.P., B.W., Y.M., D.L., S.H., S.C.K., P.H.), Positive Health Program (S.D.), San Francisco General Hospital, University of California; and Department of Medicine, San Francisco Veteran's Affairs Medical Center, University of California (R.S.)
| | - Sophia Hur
- From the Division of Cardiology, Department of Medicine (B.A.P.P., B.W., Y.M., D.L., S.H., S.C.K., P.H.), Positive Health Program (S.D.), San Francisco General Hospital, University of California; and Department of Medicine, San Francisco Veteran's Affairs Medical Center, University of California (R.S.)
| | - S C Kalapus
- From the Division of Cardiology, Department of Medicine (B.A.P.P., B.W., Y.M., D.L., S.H., S.C.K., P.H.), Positive Health Program (S.D.), San Francisco General Hospital, University of California; and Department of Medicine, San Francisco Veteran's Affairs Medical Center, University of California (R.S.)
| | - Steven Deeks
- From the Division of Cardiology, Department of Medicine (B.A.P.P., B.W., Y.M., D.L., S.H., S.C.K., P.H.), Positive Health Program (S.D.), San Francisco General Hospital, University of California; and Department of Medicine, San Francisco Veteran's Affairs Medical Center, University of California (R.S.)
| | - Priscilla Hsue
- From the Division of Cardiology, Department of Medicine (B.A.P.P., B.W., Y.M., D.L., S.H., S.C.K., P.H.), Positive Health Program (S.D.), San Francisco General Hospital, University of California; and Department of Medicine, San Francisco Veteran's Affairs Medical Center, University of California (R.S.).
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HIV and coronary disease – When secondary prevention is insufficient. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.repce.2016.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Abstract
OPINION STATEMENT Atherosclerotic disease, a primary cause of stroke and myocardial infarction, is the most common underlying cause of death worldwide. While atherosclerosis was formerly considered to be a relatively inert structural abnormality, decades of research have since shown that it is a biologically active process, driven by active inflammation. In concert with this conceptual shift, newer strategies to image vascular lesions have evolved. 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) imaging has been validated as a non-invasive tool to characterize atherosclerotic inflammation. It is hypothesized that a combination of structural and biological (e.g., inflammatory) imaging may provide better means to assess clinical risk, to assess efficacy of therapy, and to identify new, effective treatments. Limitations remain, however, and further advances in technology and tracer development are required before FDG PET imaging will contribute a significant clinical impact at the level of the individual patient.
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10
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Cardiovascular disease in human immunodeficiency virus-infection as a cause of hospitalization: a case-series in a General Hospital in Peru. Braz J Infect Dis 2015; 19:431-5. [PMID: 25892316 PMCID: PMC9427453 DOI: 10.1016/j.bjid.2015.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 03/03/2015] [Accepted: 03/05/2015] [Indexed: 12/16/2022] Open
Abstract
Background Cardiovascular disease in the context of human immunodeficiency virus infection has become a major clinical concern in recent years. In the current report we assess hospitalizations due to cardiovascular disease in human immunodeficiency virus patients in a Social Security reference hospital in Peru. Methods A retrospective study was carried out between January 1996 and December 2012 in a General Hospital in Lima, Peru. Results We included 26 patients hospitalized due to cardiovascular disease. Mean age was 46.3 years (SD 12.5), predominantly male (57.7%). Ten patients (38.4%) were in Acquired Immunodeficiency Syndrome stages. Seventeen (65.4%) received high-active-antiretroviral therapy. Eleven (42.3%) had cardiac involvement and 15 (57.7%) had non-cardiac vascular involvement. The most frequent causes of cardiac involvement were pericardial effusion and myocardial infarction. On the other hand, deep vein thrombosis and stroke were the most frequent for non-cardiac vascular involvement. Conclusions Cardiovascular disease is an important cause of hospitalization in Peruvian human immunodeficiency virus patients, with differences between immunosuppression stages. Further studies analyzing associated factors are warranted.
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Abdollahi A, Shoar S. Comparison of Adenosine Deaminase, Zinc, Magnesium, Lipid Profile, and some Micronutrient Elements and their Relation with CD4 Counts in Human Immunodeficiency Virus Positive and Negative Patients. J Glob Infect Dis 2013; 4:199-206. [PMID: 23326077 PMCID: PMC3543539 DOI: 10.4103/0974-777x.103897] [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: 11/04/2022] Open
Abstract
BACKGROUND There is strong evidence regarding the patterns of alteration in the blood parameters in human immunodeficiency virus (HIV)-positive patients. However, no consensus has been reached in this regard and the results vary from different regions and studies. Our study aims to report these patterns in a population of HIV-infected patients in Iran. MATERIALS AND METHODS We studied two groups of HIV-infected and HIV-negative patients. One hundred and fourteen subjects were enrolled in each group; blood parameters were compared in these two. RESULTS Variables of HIV-negative patients changed as follows compared to HIV-positive patients: with regard to the hematological variables, CD4+↓; CD8+↓; WBC↓; RBC↓; HCT↓; MCV↑; MCH↑; MCHC↑; PLT↓; EOS↑; and BASO↑; and among the metabloic parameters, TG↓; CH↑; HDL↓; LDL↓, MG↑; ZN↑; P↑; and ADA↓, which showed significnat differences between groups (P < 0.05). CONCLUSION We conclude that HIV infection affects hematopoiesis by diminishing the hematological productivity parameters and increasing red blood cell related morphology, along with a different pattern of lipid profile (decreased TG, LDL, HDL, and increased CH) and serum micronutrients (elevated concentration of serum trace elements) in our population of study.
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12
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Esser S, Gelbrich G, Brockmeyer N, Goehler A, Schadendorf D, Erbel R, Neumann T, Reinsch N. Prevalence of cardiovascular diseases in HIV-infected outpatients: results from a prospective, multicenter cohort study. Clin Res Cardiol 2012; 102:203-13. [DOI: 10.1007/s00392-012-0519-0] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2012] [Accepted: 10/23/2012] [Indexed: 10/27/2022]
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Ludka O, Konecny T, Pozdisek Z, Cerny J, Spinar J. Right ventricular mass in an asymptomatic HIV positive patient. J Card Surg 2012; 27:322-4. [PMID: 22296577 DOI: 10.1111/j.1540-8191.2011.01377.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Human immunodeficiency virus (HIV)- positive patients are known to have a higher risk of cardiovascular complications that are related to the underlying infection itself and also to the complications of their medical treatment. As longevity of these patients has increased owing to the advances in antiretroviral therapies, cardiovascular diseases including coagulative disorders may be more commonly encountered. A case of a right ventricular mass in an asymptomatic HIV positive patient detected by echocardiography is presented and the surgical management is described.
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Affiliation(s)
- Ondrej Ludka
- Department of Internal Cardiology, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic.
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14
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Takahashi R, Taguchi N, Suzuki M, Cheng XW, Numaguchi Y, Tsukamoto H, Ikeda N, Murohara T, Okumura K. Cholesterol and Triglyceride Concentrations in Lipoproteins as Related to Carotid Intima-Media Thickness. Int Heart J 2012; 53:29-34. [DOI: 10.1536/ihj.53.29] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
| | | | | | - Xian Wu Cheng
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Yasushi Numaguchi
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | | | | | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Kenji Okumura
- Department of Cardiology, Toki Municipal General Hospital
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Perelló R, Calvo M, Miró O, Castañeda M, Saubí N, Camón S, Foix A, Gatell JM, Masotti M, Mallolas J, Sánchez M, Martinez E. Clinical presentation of acute coronary syndrome in HIV infected adults: a retrospective analysis of a prospectively collected cohort. Eur J Intern Med 2011; 22:485-8. [PMID: 21925057 DOI: 10.1016/j.ejim.2011.02.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2010] [Revised: 02/06/2011] [Accepted: 02/21/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To compare clinical presentation and short-term prognosis of acute coronary syndrome (ACS) in HIV-infected and uninfected adults. DESIGN Retrospective analysis of a prospectively collected cohort. METHODS HIV-infected patients with myocardial infarction or unstable angina were identified by clinical history and specific characteristics of HIV infection were consecutively registered. Surviving patients were followed for at least one month after discharge. Risk factors for cardiovascular disease, clinical symptoms at admission, type of ACS, delivery of care, and factors associated with prognosis were compared between HIV-infected and uninfected adults. RESULTS Among 627 patients included, 44 (7%) were HIV-infected patients. HIV-infected patients were younger, more frequently men, and had higher prevalence of cardiovascular risk factors than uninfected patients. HIV-infected patients persisted frequently with less pain at Emergency Department (ED) (34% vs 82%, P<0.001) and complained of dyspnea (2% vs 15%, P<0.05) persisted in respect to HIV-uninfected patients. ST-elevation myocardial infarction was the most frequent ACS in HIV-infected patients (59% vs 24%) whereas non-ST-elevation myocardial infarction (23% vs 38%) and unstable angina (18% vs 38%) were the predominant ones in uninfected patients (P<0.001). Catheterism was performed more commonly in HIV-infected patients (75% vs 62%, P<0.01) and similarly admitted in the coronary care unit (38% vs 41%, P=0.81). The evolution was similar in both groups. When HIV-infected patients were matched by age and sex with a subgroup of 88 HIV-uninfected patients, most of the differences disappeared. CONCLUSIONS HIV-infected adults presenting with ACS are younger and have fewer symptoms than uninfected. Despite having a more established disease, short-term prognosis is similar.
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Affiliation(s)
- R Perelló
- Emergency Department, Barcelona, Spain.
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Dau B, Holodniy M. The Relationship Between HIV Infection and Cardiovascular Disease. Curr Cardiol Rev 2011; 4:203-18. [PMID: 19936197 PMCID: PMC2780822 DOI: 10.2174/157340308785160589] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2008] [Revised: 05/23/2008] [Accepted: 05/23/2008] [Indexed: 12/25/2022] Open
Abstract
Over 30 million people are currently living with human immunodeficiency virus (HIV) infection, and over 2 million new infections occur per year. HIV has been found to directly affect vascular biology resulting in an increased risk of cardiovascular disease compared to uninfected persons. Although HIV infection can now be treated effectively with combination antiretroviral medications, significant toxicities such as hyperlipidemia, diabetes, and excess cardiovascular co-morbidity; as well as the potential for significant drug-drug interactions between HIV and cardiovascular medications, present new challenges for the management of persons infected with HIV. We first review basic principles of HIV pathogenesis and treatment and then discuss relevant clinical management strategies that will be useful for cardiologists who might be involved in the care of HIV infected patients.
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Affiliation(s)
- Birgitt Dau
- VA Palo Alto Health Care System and Division of Infectious Diseases and Geographic Medicine, Stanford University, Palo Alto, CA, USA
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Becker AC, Sliwa K, Stewart S, Libhaber E, Essop AR, Zambakides CA, Essop MR. Acute coronary syndromes in treatment-naïve black South africans with human immunodeficiency virus infection. J Interv Cardiol 2009; 23:70-7. [PMID: 20015160 DOI: 10.1111/j.1540-8183.2009.00520.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND HIV patients on protease inhibitors have greater risk of acute coronary syndromes (ACS) but little is known about treatment-naïve patients. METHODS AND RESULTS Authors conducted a prospective single-center study from Soweto, South Africa, comparing the clinical and angiographic features of treatment-naïve HIV positive and negative patients with ACS. Between March 2004 and February 2008, 30 consecutive treatment-naïve HIV patients with ACS were compared to the next HIV-negative patient as a 1:1 control. HIV patients were younger (43 +/- 7 vs. 54 +/- 13, P = 0.004) and, besides smoking (73% vs. 33%, P = 0.002), had fewer risk factors than the control group with less hypertension (23% vs. 77%, P = 0.0001), diabetes (3% vs. 23%, P = 0.05), LDL hyperlipidemia (2.2 +/- 0.9 vs. 3.0 +/- 1.2, P = 0.006), and other coronary risk factors (7% vs. 53%, P = 0.0001). HDL was lower in the HIV group (0.8 +/- 0.3 vs. 1.1 +/- 0.4, P = 0.001). Atherosclerotic burden was lower in the HIV group with more normal infarct-related arteries (47% vs. 13%, P = 0.005) but a higher degree of large thrombus burden (43% vs. 17%, P = 0.02). Stents were used to a similar degree in HIV and control patients (30% vs. 37%, P = 0.78) with more target lesion revascularization in the HIV group (56% vs. 0%, P = 0.008). CONCLUSION Treatment-naïve HIV patients with ACS are younger and have fewer traditional risk factors than HIV-negative patients. HIV patients have less atherosclerotic but higher thrombotic burden which may imply a prothrombotic state in the pathogenesis of ACS in these patients.
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Affiliation(s)
- A C Becker
- Division of Cardiology, Chris Hani Baragwanath Hospital and University of the Witwatersrand, Johannesburg, South Africa.
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18
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Ivy DD, Feinstein JA, Humpl T, Rosenzweig EB. Non-congenital heart disease associated pediatric pulmonary arterial hypertension. PROGRESS IN PEDIATRIC CARDIOLOGY 2009; 27:13-23. [PMID: 21852894 DOI: 10.1016/j.ppedcard.2009.09.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Recognition of causes of pulmonary hypertension other than congenital heart disease is increasing in children. Diagnosis and treatment of any underlying cause of pulmonary hypertension is crucial for optimal management of pulmonary hypertension. This article discusses the available knowledge regarding several disorders associated with pulmonary hypertension in children: idiopathic pulmonary arterial hypertension (IPAH), pulmonary capillary hemangiomatosis, pulmonary veno-occlusive disease, hemoglobinopathies, hepatopulmonary syndrome, portopulmonary hypertension and HIV. Three classes of drugs have been extensively studied for the treatment of IPAH in adults: prostanoids (epoprostenol, treprostinil, iloprost, beraprost), endothelin receptor antagonists (bosentan, sitaxsentan, ambrisentan), and phosphodiesterase inhibitors (Sildenafil, tadalafil). These medications have been used in treatment of children with pulmonary arterial hypertension, although randomized clinical trial data is lacking. As pulmonary vasodilator therapy in certain diseases may be associated with adverse outcomes, further study of these medications is needed before widespread use is encouraged.
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Affiliation(s)
- D D Ivy
- University of Colorado Denver School of Medicine and The Children's Hospital, United States
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Ross AC, Armentrout R, O'Riordan MA, Storer N, Rizk N, Harrill D, El Bejjani D, McComsey GA. Endothelial activation markers are linked to HIV status and are independent of antiretroviral therapy and lipoatrophy. J Acquir Immune Defic Syndr 2009; 49:499-506. [PMID: 18989230 DOI: 10.1097/qai.0b013e318189a794] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To assess the association of inflammatory and endothelial activation biomarkers with the presence of lipoatrophy in HIV-infected subjects and to examine the role of HIV, antiretroviral therapy (ART), and metabolic parameters in endothelial activation and inflammation. DESIGN Prospective, cross-sectional study including 4 groups: HIV+ on ART with HIV-1 RNA<1000 copies/mL with and without clinical lipoatrophy, HIV+ ART naive, and healthy controls. METHODS We measured plasma levels of inflammatory cytokines (tumor necrosis factor-alpha, soluble tumor necrosis factor receptors I and II, interleukin-6, C-reactive protein, and myeloperoxidase) and endothelial activation markers (soluble intercellular and vascular cell adhesion molecules and von Willebrand factor). RESULTS We enrolled 182 subjects. Limb fat and lipoatrophy status were not correlated with endothelial markers. Endothelial markers were higher in HIV+ ART naive when compared with healthy controls and with HIV+ on ART but were similar between HIV+ on ART and healthy controls. Neither endothelial nor inflammatory markers were correlated with HIV duration, CD4 count, lipids, glucose, or specific ART. Strong correlations were found between some inflammatory cytokines and endothelial markers. CONCLUSIONS There is enhanced endothelial activation in ART naive, whereas HIV+ on ART has similar values to healthy controls. Lipoatrophy did not seem to affect endothelial activation. Results highlight a potential association between heightened inflammation and endothelial activation.
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Affiliation(s)
- Allison C Ross
- Department of Pediatrics, Rainbow Babies and Children's Hospital, and Department of Pediatrics and Medicine, Case Western Reserve University, Cleveland, OH 44106, USA
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Węgrzynowicz A, Skowyra A, Kaźmierczak M, Mikuła T, Wiercińska-Drapato A. Influence of HIV infection on highest cardiovascular risk. HIV & AIDS REVIEW 2009. [DOI: 10.1016/s1730-1270(10)60083-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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21
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Cardiovascular complications and atherosclerotic manifestations in the HIV-infected population: type, incidence and associated risk factors. AIDS 2008; 22 Suppl 3:S19-26. [PMID: 18845918 DOI: 10.1097/01.aids.0000327512.76126.6e] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Before the introduction of successful antiretroviral therapy (ART), cardiovascular complications in HIV-infected patients were largely those resulting from immunosuppression (e.g. myocarditis, pericarditis, tamponade). With the advent of ART, there has been a spectacular decrease in morbidity and mortality in HIV-infected individuals. However, alongside metabolic complications caused by ART such as insulin resistance, dyslipidemia and lipodystrophy syndrome have been observed, which potentially increase the risk of cardiovascular complications, in particular coronary artery disease. Whether HIV infection and ART are independent and individual coronary risk factors is still controversial. More and more data are available demonstrating that increasing the duration of exposure to ART, and in particular protease inhibitors, increases the risk of myocardial infarction. At the same time, chronic infection, inflammation and the disruption of immune balance as a result of HIV infection itself may have the potential to alter vascular structure and function. In this article, we will review cardiovascular complications in HIV-infected patients before and after the advent of ART, focusing on coronary artery disease, its diagnosis, prognosis and therapy.
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Abstract
Two well-recognized patterns of calcification occur in large- and medium-sized arteries, intimal calcification associated with atherosclerosis and medial calcification described by Mönckeberg. Calcification limited to the internal elastic lamina is a third pattern of calcification not previously reported in coronary arteries. Here we describe 19 cases of coronary artery internal elastic lamina calcification. We serially sectioned and examined the coronary arteries of 66 patients with advanced AIDS and 27 HIV- controls with other chronic illnesses. We observed calcification of the internal elastic lamina in 10 HIV+ patients and 9 controls. HIV- patients with internal elastic lamina calcification were significantly older than HIV- patients without it (P=0.008) and HIV+ patients with it (P=0.006). Occasionally, calcification encroached on adjacent intimal or medial tissue with mild fibrosis. There was frequent disruption of the internal elastic lamina but no evidence of inflammation. Calcification was the dominant histologic feature in all cases. Von Kossa, Alizarin red, and trichrome/elastic stains confirmed these findings. Patients with internal elastic lamina calcification often had extensive medical histories but did not suffer from chronic renal failure or other conditions known to cause calcium dysregulation. We describe coronary internal elastic lamina calcification in HIV+ patients and older HIV- adults. The clinical significance of this finding is unknown. It could lead to arterial stiffening and increased pulse pressure and could be mistaken for intimal calcification on coronary imaging. Internal elastic lamina calcification may result from premature aging due to HIV disease and chronic illness or from metabolic disorders in HIV+ patients.
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Schuster I, Thöni GJ, Edérhy S, Walther G, Nottin S, Vinet A, Boccara F, Khireddine M, Girard PM, Mauboussin JM, Rouanet I, Dauzat M, Cohen A, Messner-Pellenc P, Obert P. Subclinical cardiac abnormalities in human immunodeficiency virus-infected men receiving antiretroviral therapy. Am J Cardiol 2008; 101:1213-7. [PMID: 18394461 DOI: 10.1016/j.amjcard.2007.11.073] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2007] [Revised: 11/29/2007] [Accepted: 11/29/2007] [Indexed: 10/22/2022]
Abstract
Although cardiotoxic effects of highly active antiretroviral therapy (HAART) are a growing concern, there is a lack of prospective studies of subclinical involvement of the heart in human immunodeficiency virus (HIV)-infected patients. This study evaluated noninvasively cardiac morphologic characteristics and function in HIV-positive (HIV(+)) men receiving HAART for > or =2 years with no clinical evidence of cardiovascular disease. Echocardiography at rest, including tissue Doppler imaging and exercise testing, were performed in 30 HIV(+) men (age 42.1 +/- 4.7 years, duration of HIV infection 10.4 +/- 4.7 years, duration of HAART 5.3 +/- 2.1 years) and 26 age-matched healthy controls. At rest, HIV(+) patients had similar left ventricular (LV) mass indexed to height(2.7) (40.6 +/- 9.5 vs 37.5 +/- 9.3 g/m; p >0.05), but a higher prevalence of LV diastolic dysfunction (abnormal relaxation or pseudonormal filling pattern in 64% of patients vs 12% of controls; p <0.001). LV systolic function indexes were significantly lower (ejection fraction 60.4 +/- 8.7% vs 66.9 +/- 6.9%; p <0.01, and tissue Doppler imaging peak systolic velocity 11.4 +/- 1.6 vs 13.5 +/- 2.2 cm/s; p <0.001). Pulmonary artery pressure was higher in patients compared with controls (32.1 +/- 5.4 vs 26.1 +/- 6.5 mm Hg; p <0.001). Exercise testing showed decreased exercise tolerance in HIV(+) patients, with no case of myocardial ischemia. In conclusion, subclinical cardiac abnormalities are frequently observed in HIV(+) patients on HAART. The usefulness of systematic noninvasive screening in this population should be considered. GECEM study no. 30: National Agency for AIDS Research (ANRS).
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Coronary atherosclerotic lesions in human immunodeficiency virus-infected patients: a histopathologic study. Cardiovasc Pathol 2008; 18:28-36. [PMID: 18402832 DOI: 10.1016/j.carpath.2007.12.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2007] [Revised: 12/05/2007] [Accepted: 12/27/2007] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Studies suggest human immunodeficiency virus-positive (HIV+) patients have an increased risk of coronary artery disease (CAD), yet little is known about the histopathology, severity, or distribution of lesions. METHODS The coronary arteries of 66 deceased AIDS patients and 19 HIV controls (age <55) were dissected and graded for percent luminal stenosis by intimal lesions, percent of intima involved with lipid, and extent of intimal calcification on a scale of 0 to 3. Medical histories, antiretroviral therapies, and CAD risk factors were reviewed. RESULTS HIV+ patients were older than controls (P=.06), and more were male (P=.02). Thirty-five percent of HIV+ patients had stenosis >or=75% of at least one artery. Compared to controls, HIV+ patients had three times greater odds of stenosis >or=75%, controlling for age and sex (one-sided P=.03). Older age and male sex were also risk factors (one-sided P<.001). HIV seropositivity was associated with increased plaque lipid content (one-sided P=.02) and calcification (one-sided P=.08). Duration of HIV infection, antiretroviral therapy, and immune status did not predict severe disease in multivariate analyses. Previously unreported patterns of dystrophic calcification were observed in HIV+ patients and older controls. CONCLUSIONS Young to middle-aged patients dying from advanced AIDS have atherosclerotic CAD that may result in luminal narrowing, heavy calcification, and high plaque lipid content. The pattern of disease, location of lesions, and plaque composition are typical of atherosclerosis in HIV-negative patients. No relationship between antiretroviral therapies and atherosclerosis was seen in this small study of heavily treated patients.
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Lima GSD, Cavalcante TDMC, Isabella APJ, Magalhães ADS. Assistência de enfermagem a um paciente infartado portador de HIV, baseada na teoria do autocuidado: estudo de caso. ACTA PAUL ENFERM 2007. [DOI: 10.1590/s0103-21002007000400011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJETIVO: Aplicar a Sistematização da Assistência de Enfermagem (SAE) a um paciente portador de HIV e infartado. MÉTODOS: Trata-se de um estudo de caso realizado em um hospital escola localizado na região metropolitana de São Paulo, em novembro de 2003, utilizando a Sistematização da Assistência de Enfermagem e propondo diagnósticos de enfermagem com base na taxonomia II NANDA bem como as intervenções de enfermagem relacionadas. RESULTADOS: Os principais diagnósticos de enfermagem identificados foram: Risco para controle ineficaz do regime terapêutico, ansiedade, perfusão tissular cardíaca alterada, mobilidade física prejudicada, proteção alterada, risco para infecção, entre outros. CONCLUSÃO: O estudo mostrou a importância da Sistematização da Assistência de Enfermagem e da decisão do paciente em engajar-se no autocuidado a fim de proporcionar uma melhora no padrão de resposta do doente à doença.
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Bukrinsky M, Sviridov D. Human immunodeficiency virus infection and macrophage cholesterol metabolism. J Leukoc Biol 2007; 80:1044-51. [PMID: 17056763 DOI: 10.1189/jlb.0206113] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Macrophages play a central role in the pathogenesis of atherosclerosis and are also a host for a number of viruses, most importantly, HIV. Many viruses, including HIV, require cholesterol for their replication and as a structural element. Cholesterol also plays a pivotal role in innate antiviral immune responses. Although impairing innate immune response by increasing cell cholesterol content may be a deliberate strategy used by a pathogen to improve its infectivity, enhancing the risk of atherosclerosis is likely a byproduct. Consistent association between HIV infection and elevated risk of atherosclerosis suggested a connection between virus-induced changes in cholesterol metabolism and atherogenesis, but the mechanisms of such connection have not been identified. We describe in this review various mechanisms enabling viruses to exploit macrophage pathways of cholesterol metabolism, thus diverting cholesterol for a purpose of increasing viral replication and/or for altering innate immune responses. To alter the cellular cholesterol content, viruses "hijack" the pathways responsible for maintaining intracellular cholesterol metabolism. The damage to these pathways by viral infection may result in the inability of macrophages to control cholesterol accumulation and may lead to formation of foam cells, a characteristic feature of atherosclerosis. Further elucidation of the mechanisms connecting viral infection and macrophage cholesterol metabolism may be fruitful for developing approaches to treatment of atherosclerosis and viral diseases.
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Affiliation(s)
- Michael Bukrinsky
- Department of Microbiology, Immunology and Tropical Medicine, 2300 I St., N.W., Ross Hall, Rm. 234, Washington, DC 20037, USA.
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Horwich TB, Fonarow GC. CARDIOVASCULAR AND SURVIVAL PARADOXES IN DIALYSIS PATIENTS: Reverse Epidemiology beyond Dialysis Patients: Chronic Heart Failure, Geriatrics, Rheumatoid Arthritis, COPD, and AIDS. Semin Dial 2007; 20:549-53. [DOI: 10.1111/j.1525-139x.2007.00346.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kalantar-Zadeh K, Horwich TB, Oreopoulos A, Kovesdy CP, Younessi H, Anker SD, Morley JE. Risk factor paradox in wasting diseases. Curr Opin Clin Nutr Metab Care 2007; 10:433-42. [PMID: 17563461 DOI: 10.1097/mco.0b013e3281a30594] [Citation(s) in RCA: 236] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW Emerging data indicate that conventional cardiovascular risk factors (e.g. hypercholesterolemia and obesity) are paradoxically associated with better survival in distinct populations with wasting. We identify these populations and review survival paradoxes and common pathophysiologic mechanisms. RECENT FINDINGS A 'reverse epidemiology' of cardiovascular risk is observed in chronic kidney disease, chronic heart failure, chronic obstructive lung disease, cancer, AIDS and rheumatoid arthritis, and in the elderly. These populations apparently have slowly progressive to full-blown wasting and significantly greater short-term mortality than the general population. The survival paradoxes may result from the time differential between the two competing risk factors [i.e. over-nutrition (long-term killer but short-term protective) versus undernutrition (short-term killer)]. Hemodynamic stability of obesity, protective adipokine profile, endotoxin-lipoprotein interaction, toxin sequestration of fat, antioxidation of muscle, reverse causation, and survival selection may also contribute. SUMMARY The seemingly counterintuitive risk factor paradox is the hallmark of chronic disease states or conditions associated with wasting disease at the population level. Studying similarities among these populations may help reveal common pathophysiologic mechanisms of wasting disease, leading to a major shift in clinical medicine and public health beyond the conventional Framingham paradigm and to novel therapeutic approaches related to wasting and short-term mortality.
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Affiliation(s)
- Kamyar Kalantar-Zadeh
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Los Angeles Biomedical Research Center at Harbor-UCLA, Torrance, California 90509-2910, USA.
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Hsue PY, Waters DD. Treatment of Cardiovascular Manifestations of HIV. Cardiovasc Ther 2007. [DOI: 10.1016/b978-1-4160-3358-5.50054-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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