1
|
Bajdechi M, Gurghean A, Bataila V, Scafa-Udriște A, Bajdechi GE, Radoi R, Oprea AC, Chioncel V, Mateescu I, Zekra L, Cernat R, Dumitru IM, Rugina S. Particular Aspects Related to CD4+ Level in a Group of HIV-Infected Patients and Associated Acute Coronary Syndrome. Diagnostics (Basel) 2023; 13:2682. [PMID: 37627941 PMCID: PMC10453880 DOI: 10.3390/diagnostics13162682] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/11/2023] [Accepted: 08/13/2023] [Indexed: 08/27/2023] Open
Abstract
People living with HIV infection are at high risk for cardiovascular events due to inflammation and atherosclerosis. Also, some antiretroviral therapies may contribute to the risk of cardiovascular complications. Immune status is highly dependent on the level of lymphocyte T helper CD4+. There are data suggesting that immune status and CD4+ cell count may be involved in the development of cardiovascular complications in these patients. Our study is longitudinal and retrospective and included a total number of 50 patients with HIV infection associated with acute coronary syndrome, divided into two subgroups based on the nadir of CD4+ cells. This study analyzes the relationship between the immune status of HIV patients, assessed by the nadir of the CD4+ T-cell count, and the outcome of these patients. Also, secondary endpoints were the assessment of the magnitude of coronary lesions and of thrombotic and bleeding risk assessed by specific scores. Clinical and biological parameters and also the extension and complexity of coronary lesions were assessed. Although patients with poor immune status had more complex coronary lesions and increased operative risk and bleeding risk at one year, this was not associated with significant differences in major adverse cardiac and cerebrovascular events at the 30-day and 1-year outcomes.
Collapse
Affiliation(s)
- Mircea Bajdechi
- Faculty of Medicine, University of Medicine and Pharmacy “Carol Davila” of Bucharest, 050474 Bucharest, Romania; (M.B.); (A.S.-U.); (G.-E.B.); (A.C.O.); (V.C.); (I.M.)
- Doctoral School of Medicine, “Ovidius” University of Constanta, 900470 Constanta, Romania; (L.Z.); (R.C.); (I.M.D.); (S.R.)
| | - Adriana Gurghean
- Faculty of Medicine, University of Medicine and Pharmacy “Carol Davila” of Bucharest, 050474 Bucharest, Romania; (M.B.); (A.S.-U.); (G.-E.B.); (A.C.O.); (V.C.); (I.M.)
| | - Vlad Bataila
- Emergency Clinical Hospital of Bucharest, 014461 Bucharest, Romania
| | - Alexandru Scafa-Udriște
- Faculty of Medicine, University of Medicine and Pharmacy “Carol Davila” of Bucharest, 050474 Bucharest, Romania; (M.B.); (A.S.-U.); (G.-E.B.); (A.C.O.); (V.C.); (I.M.)
- Emergency Clinical Hospital of Bucharest, 014461 Bucharest, Romania
| | - Georgiana-Elena Bajdechi
- Faculty of Medicine, University of Medicine and Pharmacy “Carol Davila” of Bucharest, 050474 Bucharest, Romania; (M.B.); (A.S.-U.); (G.-E.B.); (A.C.O.); (V.C.); (I.M.)
| | - Roxana Radoi
- Clinical Hospital of Infectious and Tropical Disease “Dr. Victor Babes” of Bucharest, 030303 Bucharest, Romania;
| | - Anca Cristiana Oprea
- Faculty of Medicine, University of Medicine and Pharmacy “Carol Davila” of Bucharest, 050474 Bucharest, Romania; (M.B.); (A.S.-U.); (G.-E.B.); (A.C.O.); (V.C.); (I.M.)
- Clinical Hospital of Infectious and Tropical Disease “Dr. Victor Babes” of Bucharest, 030303 Bucharest, Romania;
| | - Valentin Chioncel
- Faculty of Medicine, University of Medicine and Pharmacy “Carol Davila” of Bucharest, 050474 Bucharest, Romania; (M.B.); (A.S.-U.); (G.-E.B.); (A.C.O.); (V.C.); (I.M.)
| | - Iuliana Mateescu
- Faculty of Medicine, University of Medicine and Pharmacy “Carol Davila” of Bucharest, 050474 Bucharest, Romania; (M.B.); (A.S.-U.); (G.-E.B.); (A.C.O.); (V.C.); (I.M.)
| | - Lucia Zekra
- Doctoral School of Medicine, “Ovidius” University of Constanta, 900470 Constanta, Romania; (L.Z.); (R.C.); (I.M.D.); (S.R.)
- Clinical Infectious Disease Hospital of Constanta, 900178 Constanta, Romania
| | - Roxana Cernat
- Doctoral School of Medicine, “Ovidius” University of Constanta, 900470 Constanta, Romania; (L.Z.); (R.C.); (I.M.D.); (S.R.)
- Clinical Infectious Disease Hospital of Constanta, 900178 Constanta, Romania
| | - Irina Magdalena Dumitru
- Doctoral School of Medicine, “Ovidius” University of Constanta, 900470 Constanta, Romania; (L.Z.); (R.C.); (I.M.D.); (S.R.)
- Clinical Infectious Disease Hospital of Constanta, 900178 Constanta, Romania
| | - Sorin Rugina
- Doctoral School of Medicine, “Ovidius” University of Constanta, 900470 Constanta, Romania; (L.Z.); (R.C.); (I.M.D.); (S.R.)
- Clinical Infectious Disease Hospital of Constanta, 900178 Constanta, Romania
- Romanian Academy of Medical Sciences, 030167 Bucharest, Romania
- Academy of Romanian Scientists, 050045 Bucharest, Romania
| |
Collapse
|
2
|
Bajdechi M, Gurghean A, Bataila V, Scafa-Udriste A, Radoi R, Oprea AC, Marinescu A, Ion S, Chioncel V, Nicula A, Anastasiou A, Bajdechi GE, Savulescu-Fiedler I, Dumitru IM, Rugina S. Cardiovascular Risk Factors, Angiographical Features and Short-Term Prognosis of Acute Coronary Syndrome in People Living with Human Immunodeficiency Virus: Results of a Retrospective Observational Multicentric Romanian Study. Diagnostics (Basel) 2023; 13:diagnostics13091526. [PMID: 37174918 PMCID: PMC10177561 DOI: 10.3390/diagnostics13091526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 04/19/2023] [Accepted: 04/20/2023] [Indexed: 05/15/2023] Open
Abstract
People living with human immunodeficiency virus have increased cardiovascular risk due to a higher prevalence of traditional and particular risk factors such as chronic inflammation, immune dysregulation, endothelial dysfunction, coagulation abnormalities and antiretroviral therapy. In developed countries, coronary artery disease has become the most frequent cardiovascular disease and an important cause of mortality in these patients. The symptomatology of an acute coronary syndrome can be atypical, and the prevalence of each type of acute coronary syndrome is reported differently. Regarding coronary artery disease severity in people living with HIV, the literature data indicates that the presence of single-vessel disease is akin to that of HIV-negative patients, and their short-term prognosis is unclear. This study aims to assess the clinical characteristics, biological parameters, angiographical features and short-term prognosis of acute coronary syndrome in a cohort of Romanian people living with human immunodeficiency virus.
Collapse
Affiliation(s)
- Mircea Bajdechi
- Faculty of Medicine, University of Medicine and Pharmacy "Carol Davila" of Bucharest, 050474 Bucharest, Romania
- Doctoral School of Medicine, "Ovidius" University of Constanta, 900470 Constanta, Romania
| | - Adriana Gurghean
- Faculty of Medicine, University of Medicine and Pharmacy "Carol Davila" of Bucharest, 050474 Bucharest, Romania
| | - Vlad Bataila
- Emergency Clinical Hospital of Bucharest, 014461 Bucharest, Romania
| | - Alexandru Scafa-Udriste
- Faculty of Medicine, University of Medicine and Pharmacy "Carol Davila" of Bucharest, 050474 Bucharest, Romania
- Emergency Clinical Hospital of Bucharest, 014461 Bucharest, Romania
| | - Roxana Radoi
- Clinical Hospital of Infectious and Tropical Disease "Dr. Victor Babes" of Bucharest, 030303 Bucharest, Romania
| | - Anca Cristiana Oprea
- Faculty of Medicine, University of Medicine and Pharmacy "Carol Davila" of Bucharest, 050474 Bucharest, Romania
- Clinical Hospital of Infectious and Tropical Disease "Dr. Victor Babes" of Bucharest, 030303 Bucharest, Romania
| | - Adrian Marinescu
- National Institute of Infectious Disease "Prof. Dr. Matei Bals" of Bucharest, 021105 Bucharest, Romania
| | - Stefan Ion
- Faculty of Medicine, "Titu Maiorescu" University of Bucharest, 040441 Bucharest, Romania
| | - Valentin Chioncel
- Faculty of Medicine, University of Medicine and Pharmacy "Carol Davila" of Bucharest, 050474 Bucharest, Romania
| | - Alina Nicula
- Faculty of Medicine, University of Medicine and Pharmacy "Carol Davila" of Bucharest, 050474 Bucharest, Romania
| | - Achilleas Anastasiou
- Departament of Statistics and Actuarial-Financial Mathematics, Laboratory of Statistics and Data Analysis, University of Aegean, 83200 Samos, Greece
| | - Georgiana-Elena Bajdechi
- Faculty of Medicine, University of Medicine and Pharmacy "Carol Davila" of Bucharest, 050474 Bucharest, Romania
| | - Ilinca Savulescu-Fiedler
- Faculty of Medicine, University of Medicine and Pharmacy "Carol Davila" of Bucharest, 050474 Bucharest, Romania
| | - Irina Magdalena Dumitru
- Doctoral School of Medicine, "Ovidius" University of Constanta, 900470 Constanta, Romania
- Clinical Infectious Disease Hospital of Constanta, 900178 Constanta, Romania
| | - Sorin Rugina
- Doctoral School of Medicine, "Ovidius" University of Constanta, 900470 Constanta, Romania
- Clinical Infectious Disease Hospital of Constanta, 900178 Constanta, Romania
- Romanian Academy of Medical Sciences, 030167 Bucuresti, Romania
- Academy of Romanian Scientists, 030167 Bucuresti, Romania
| |
Collapse
|
3
|
Bajdechi M, Mihai C, Scafa-Udriste A, Cherry A, Zamfir D, Dumitru I, Cernat R, Rugina S. Severe Coronary Artery Disease in a Person Living with HIV. ACTA ACUST UNITED AC 2021; 57:medicina57060595. [PMID: 34200527 PMCID: PMC8229972 DOI: 10.3390/medicina57060595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 06/07/2021] [Indexed: 01/18/2023]
Abstract
The pathophysiology of accelerated atherosclerosis in people living with Human Immunofediciency virus (HIV) is complex. Coronary artery disease (CAD) has become an important cause of mortality in these patients. They often have atypical symptoms, leading to frequently missed diagnoses. We report a case of a 51-year-old male undergoing antiretroviral therapy who was admitted for acute coronary syndrome. He had severe coronary artery disease that involved difficult management.
Collapse
Affiliation(s)
- Mircea Bajdechi
- Faculty of Medicine, University “Ovidius” of Constanta, 900470 Constanța, Romania; (I.D.); (R.C.)
- Emergency Clinical Hospital of Bucharest, 014461 București, Romania; (C.M.); (A.S.-U.); (A.C.); (D.Z.)
- Correspondence: (M.B.); (S.R.); Tel.: +40-720569706 (M.B.)
| | - Cosmin Mihai
- Emergency Clinical Hospital of Bucharest, 014461 București, Romania; (C.M.); (A.S.-U.); (A.C.); (D.Z.)
| | - Alexandru Scafa-Udriste
- Emergency Clinical Hospital of Bucharest, 014461 București, Romania; (C.M.); (A.S.-U.); (A.C.); (D.Z.)
- 4th Department, Cardio-Thoracic Pathology, University of Medicine and Pharmacy “Carol Davila” Bucharest, 050474 București, Romania
| | - Ali Cherry
- Emergency Clinical Hospital of Bucharest, 014461 București, Romania; (C.M.); (A.S.-U.); (A.C.); (D.Z.)
| | - Diana Zamfir
- Emergency Clinical Hospital of Bucharest, 014461 București, Romania; (C.M.); (A.S.-U.); (A.C.); (D.Z.)
| | - Irina Dumitru
- Faculty of Medicine, University “Ovidius” of Constanta, 900470 Constanța, Romania; (I.D.); (R.C.)
| | - Roxana Cernat
- Faculty of Medicine, University “Ovidius” of Constanta, 900470 Constanța, Romania; (I.D.); (R.C.)
| | - Sorin Rugina
- Faculty of Medicine, University “Ovidius” of Constanta, 900470 Constanța, Romania; (I.D.); (R.C.)
- Correspondence: (M.B.); (S.R.); Tel.: +40-720569706 (M.B.)
| |
Collapse
|
4
|
Seecheran R, Kawall T, Seecheran V, Persad S, Kanhai J, Jagdeo CL, Giddings S, Raza S, Seecheran NA. <p>Chronic Total Occlusion of the Left Main Coronary Artery in an HIV-Infected Patient</p>. Int Med Case Rep J 2020; 13:623-629. [PMID: 33209063 PMCID: PMC7669524 DOI: 10.2147/imcrj.s279824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 10/17/2020] [Indexed: 11/23/2022] Open
Abstract
Coronary artery disease (CAD) is amongst the leading causes of death in human immunodeficiency virus (HIV)-infected persons. Severe left main disease (LMD) occurs in approximately five percent of HIV-infected patients, with chronic total occlusion (CTO) of this vessel being an even rarer phenomenon. We describe a non-adherent HIV-infected patient with a left main coronary artery (LMCA) CTO that presented with heart failure with mildly reduced ejection fraction (HFrEF) and ventricular tachycardia (VT).
Collapse
Affiliation(s)
- Rajeev Seecheran
- Department of Medicine, North Central Regional Health Authority, Mt. Hope, Trinidad and Tobago
| | - Tiffany Kawall
- Department of Medicine, North Central Regional Health Authority, Mt. Hope, Trinidad and Tobago
| | - Valmiki Seecheran
- Department of Medicine, North Central Regional Health Authority, Mt. Hope, Trinidad and Tobago
| | - Sangeeta Persad
- Department of Medicine, North Central Regional Health Authority, Mt. Hope, Trinidad and Tobago
| | - Joel Kanhai
- Cardiology Unit, Advanced Cardiovascular Institute, Port of Spain, Trinidad and Tobago
| | - Cathy-Lee Jagdeo
- Department of Medicine, North Central Regional Health Authority, Mt. Hope, Trinidad and Tobago
| | - Stanley Giddings
- Department of Clinical Medical Sciences, Faculty of Medical Sciences, University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Sadi Raza
- Department of Cardiovascular Services, HeartPlace Dallas, Dallas, TX, USA
| | - Naveen Anand Seecheran
- Department of Clinical Medical Sciences, Faculty of Medical Sciences, University of the West Indies, St. Augustine, Trinidad and Tobago
- Correspondence: Naveen Anand Seecheran Department of Clinical Medical Sciences, Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Trinidad, Trinidad and TobagoTel +868 663-4332 Email
| |
Collapse
|
5
|
Abstract
Antiretroviral therapy has largely transformed HIV infection into a chronic disease condition. As such, physicians and other providers caring for individuals living with HIV infection need to be aware of the potential cardiovascular complications of HIV infection and the nuances of how HIV infection increases the risk of cardiovascular diseases, including acute myocardial infarction, stroke, peripheral artery disease, heart failure and sudden cardiac death, as well as how to select available therapies to reduce this risk. In this Review, we discuss the epidemiology and clinical features of cardiovascular disease, with a focus on coronary heart disease, in the setting of HIV infection, which includes a substantially increased risk of myocardial infarction even when the HIV infection is well controlled. We also discuss the mechanisms underlying HIV-associated atherosclerotic cardiovascular disease, such as the high rates of traditional cardiovascular risk factors in patients with HIV infection and HIV-related factors, including the use of antiretroviral therapy and chronic inflammation in the setting of effectively treated HIV infection. Finally, we highlight available therapeutic strategies, as well as approaches under investigation, to reduce the risk of cardiovascular disease and lower inflammation in patients with HIV infection.
Collapse
Affiliation(s)
- Priscilla Y Hsue
- University of California-San Francisco, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA.
| | - David D Waters
- University of California-San Francisco, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
| |
Collapse
|
6
|
Seecheran R, Seecheran V, Persad S, Dookie T, Seecheran NA. Atypical presentation of critical left main disease in an HIV-infected patient. Int Med Case Rep J 2018; 11:139-143. [PMID: 29950906 PMCID: PMC6016272 DOI: 10.2147/imcrj.s164642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Coronary artery disease is currently one of the leading causes of mortality in patients with HIV. Severe left main disease (LMD) occurs in ~6% of the HIV-infected patients. We describe a case report of an atypical presentation of silent critical LMD in an HIV-infected patient who underwent a low-risk exercise stress test. The cardiovascular disease team should be vigilant for this latent phenomenon, specifically within this subpopulation despite the high Duke treadmill score.
Collapse
Affiliation(s)
- Rajeev Seecheran
- Department of Clinical Medical Sciences, University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Valmiki Seecheran
- Cardiovascular Services Division, North West Regional Health Authority, Mt. Hope, Trinidad and Tobago
| | - Sangeeta Persad
- Cardiovascular Services Division, North West Regional Health Authority, Mt. Hope, Trinidad and Tobago
| | - Taarik Dookie
- Cardiology Unit, Advanced Cardiovascular Institute, Port of Spain, Trinidad and Tobago
| | - Naveen Anand Seecheran
- Department of Clinical Medical Sciences, University of the West Indies, St. Augustine, Trinidad and Tobago
| |
Collapse
|
7
|
Sood V, Jermy S, Saad H, Samuels P, Moosa S, Ntusi N. Review of cardiovascular magnetic resonance in human immunodeficiency virus-associated cardiovascular disease. SA J Radiol 2017; 21:1248. [PMID: 31754483 PMCID: PMC6837809 DOI: 10.4102/sajr.v21i2.1248] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 08/28/2017] [Indexed: 11/01/2022] Open
Abstract
Despite ongoing advances in the treatment of patients with human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS), they remain a major global public health concern conferring an increased risk of morbidity and mortality in affected individuals. This is, in part, because of the widespread dysfunction imposed by HIV and its treatment on the cardiovascular system, including the myocardium, valvular apparatus, pericardium and coronary, pulmonary and peripheral vasculature. In recent times, cardiovascular magnetic resonance (CMR) imaging has emerged as the gold standard tool for assessment of a variety of indications, allowing comprehensive characterisation of functional, morphological, metabolic and haemodynamic sequelae of several cardiovascular pathologies. Furthermore, continued advancement in imaging techniques has yielded novel insights into the underlying pathophysiology and guides future therapeutic strategies. In this article, we review the various clinical phenotypes of HIV-associated cardiovascular disease and highlight the utility of CMR in their assessment.
Collapse
Affiliation(s)
- Vishesh Sood
- Division of Radiology, Department of Radiation Medicine, University of Cape Town.,Groote Schuur Hospital, Cape Town, South Africa
| | - Stephen Jermy
- Cape Universities Body Imaging Centre, University of Cape Town, South Africa.,Department of Medicine, University of Cape Town, South Africa
| | - Hadil Saad
- Cape Universities Body Imaging Centre, University of Cape Town, South Africa.,Department of Medicine, University of Cape Town, South Africa
| | - Petronella Samuels
- Cape Universities Body Imaging Centre, University of Cape Town, South Africa.,Department of Medicine, University of Cape Town, South Africa
| | - Sulaiman Moosa
- Division of Radiology, Department of Radiation Medicine, University of Cape Town
| | - Ntobeko Ntusi
- Cape Universities Body Imaging Centre, University of Cape Town, South Africa.,Department of Medicine, University of Cape Town, South Africa.,Hatter Institute of Cardiovascular Research in Africa, Department of Medicine, University of Cape Town, South Africa
| |
Collapse
|
8
|
Progression of coronary artery disease in a HIV-infected patient previously treated for ascending aorta aneurysm. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2017; 14:211-213. [PMID: 29181053 PMCID: PMC5701601 DOI: 10.5114/kitp.2017.70539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 06/04/2017] [Indexed: 11/18/2022]
|
9
|
Abstract
BACKGROUND Wellens syndrome is a pattern of electrocardiographic (ECG) changes in the context of unstable angina characterized with deep inverted T-waves or biphasic T-waves in the precordial leads. These specific ECG changes are highly suggestive of stenosis in the left anterior descending artery (LAD), which can result in acute myocardial infarction, left ventricular dysfunction, or death. Human immunodeficiency virus (HIV) infection is known as an independent risk factor for the cardiovascular disease. CASE REPORT The first case is a 61-year-old African American female with a history of HIV infection who presented with chest pain for 8 h. Electrocardiogram (ECG) showed deep T-waves inversions in leads V3-V6. Emergent cardiac catheterization showed 99% stenosis in the mid-LAD and a drug-eluting stent (DES) was subsequently placed. The second case is a 49-year-old African American female with a medical history of type 2 diabetes mellitus, HIV, active cigarettes smoker admitted for intermittent substernal chest pain of 1-day duration. ECG showed biphasic T-wave in V2 and deep T-waves inversion in V3-V4, coronary angiography showed 95% stenosis in the proximal LAD and a DES was placed. CONCLUSION Wellens syndrome has characteristic ECG changes that indicates LAD stenosis. Early recognition of this syndrome, especially in HIV-infected patients who are high risk for cardiovascular disease, will help to avoid impending myocardial infarction.
Collapse
Affiliation(s)
- Bowei Tan
- Department of Medicine, Brookdale University Hospital and Medical Center Department of Cardiology, Brookdale University Hospital and Medical Center, Brooklyn, NY
| | | | | | | | | |
Collapse
|
10
|
Ntusi NAB, Ntsekhe M. Human immunodeficiency virus-associated heart failure in sub-Saharan Africa: evolution in the epidemiology, pathophysiology, and clinical manifestations in the antiretroviral era. ESC Heart Fail 2016; 3:158-167. [PMID: 28834662 PMCID: PMC5657330 DOI: 10.1002/ehf2.12087] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Revised: 01/24/2016] [Accepted: 01/26/2016] [Indexed: 01/12/2023] Open
Abstract
The survival of patients with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) who have access to highly active antiretroviral therapy (ART) has dramatically increased in recent times. This review focuses on HIV‐associated heart failure in sub‐Saharan Africa (SSA). In HIV infected persons, heart failure may be related to pathology of the pericardium, the myocardium, the valves, the conduction system, or the coronary and pulmonary vasculature. HIV‐associated heart failure can be because of direct consequences of HIV infection, autoimmune reactions, pro‐inflammatory cytokines, opportunistic infections (OIs) or neoplasms, use of ART or therapy for OIs and presence of traditional cardiovascular risk factors. Myocardial involvement includes diastolic dysfunction, asymptomatic left ventricular dysfunction, cardiomyopathy, myocarditis, fibrosis, and steatosis. Pericardial diseases include pericarditis, pericardial effusions (rarely causing tamponade), pericardial constriction, and effusive‐constrictive syndromes. Coronary artery disease is commonly reported in industrial nations, although its prevalence is thought to be low in HIV‐infected persons from SSA.
Collapse
Affiliation(s)
- Ntobeko A B Ntusi
- Division of Cardiology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Mpiko Ntsekhe
- Division of Cardiology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| |
Collapse
|
11
|
Bernard MA, Han X, Inderbitzin S, Agbim I, Zhao H, Koziel H, Tachado SD. HIV-derived ssRNA binds to TLR8 to induce inflammation-driven macrophage foam cell formation. PLoS One 2014; 9:e104039. [PMID: 25090652 PMCID: PMC4121254 DOI: 10.1371/journal.pone.0104039] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 07/04/2014] [Indexed: 01/12/2023] Open
Abstract
Even though combined anti-retroviral therapy (cART) dramatically improves patient survival, they remain at a higher risk of being afflicted with non-infectious complications such as cardiovascular disease (CVD). This increased risk is linked to persistent inflammation and chronic immune activation. In this study, we assessed whether this complication is related to HIV-derived ssRNAs inducing in macrophages increases in TNFα release through TLR8 activation leading to foam cell formation. HIV ssRNAs induced foam cell formation in monocyte-derived macrophages (MDMs) in a dose-dependent manner. This response was reduced when either endocytosis or endosomal acidification was inhibited by dynasore or chloroquine, respectively. Using a flow cytometry FRET assay, we demonstrated that ssRNAs bind to TLR8 in HEK cells. In MDMs, ssRNAs triggered a TLR8-mediated inflammatory response that ultimately lead to foam cell formation. Targeted silencing of the TLR8 and MYD88 genes reduced foam cell formation. Furthermore, foam cell formation induced by these ssRNAs was blocked by an anti-TNFα neutralizing antibody. Taken together in MDMs, HIV ssRNAs are internalized; bind TLR8 in the endosome followed by endosomal acidification. TLR8 signaling then triggers TNFα release and ultimately leads to foam cell formation. As this response was inhibited by a blocking anti-TNFα antibody, drug targeting HIV ssRNA-driven TLR8 activation may serve as a potential therapeutic target to reduce chronic immune activation and inflammation leading to CVD in HIV+ patients.
Collapse
Affiliation(s)
- Mark A. Bernard
- Division of Pulmonary, Critical Care, and Sleep Medicine; Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Xinbing Han
- Division of Pulmonary, Critical Care, and Sleep Medicine; Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Sonya Inderbitzin
- Division of Pulmonary, Critical Care, and Sleep Medicine; Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Ifunanya Agbim
- Division of Pulmonary, Critical Care, and Sleep Medicine; Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Hui Zhao
- Division of Pulmonary, Critical Care, and Sleep Medicine; Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, United States of America
- From Department of Respiratory Medicine, The Second Hospital of Shanxi Medical University, Taiyuan, PR China
| | - Henry Koziel
- Division of Pulmonary, Critical Care, and Sleep Medicine; Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Souvenir D. Tachado
- Division of Pulmonary, Critical Care, and Sleep Medicine; Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail:
| |
Collapse
|
12
|
Abstract
The lifespan of HIV-infected patients is increasing, and cardiovascular diseases becoming a major comorbidity and leading cause of death in this population due to high prevalence of the cardiac risk factors and possibly due to the use of antiretroviral therapy. Aggressive reduction of these risk factors and treatment of cardiovascular diseases are crucial to decrease the cardiovascular mortality in these patients.
Collapse
|
13
|
Boccara F, Lang S, Meuleman C, Ederhy S, Mary-Krause M, Costagliola D, Capeau J, Cohen A. HIV and coronary heart disease: time for a better understanding. J Am Coll Cardiol 2013; 61:511-23. [PMID: 23369416 DOI: 10.1016/j.jacc.2012.06.063] [Citation(s) in RCA: 202] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Revised: 05/21/2012] [Accepted: 06/19/2012] [Indexed: 11/28/2022]
Abstract
Cardiovascular disease, and particularly coronary heart disease, is an emerging area of concern in the HIV population. Since the advent of efficient antiretroviral therapies and the consequent longer patient life span, an increased risk for myocardial infarction has been observed in HIV-infected patients compared with the general population in Western countries. The pathophysiology of this accelerated atherosclerotic process is complex and multifactorial. Traditional cardiovascular risk factors-overrepresented in the HIV population-associated with uncontrolled viral replication and exposure to antiretroviral drugs (per se or through lipid and glucose disturbances) could promote acute ischemic events. Thus, despite successful antiviral therapy, numerous studies suggest a role of chronic inflammation, together with immune activation, that could lead to vascular dysfunction and atherothrombosis. It is time for physicians to prevent coronary heart disease in this high-risk population through the use of tools employed in the general population. Moreover, the lower median age at which acute coronary syndromes occur in HIV-infected patients should shift prevention to include patients <45 years of age. Available cardiovascular risk scores in the general population usually fail to screen young patients at risk for myocardial infarction. Moreover, the novel vascular risk factors identified in HIV-related atherosclerosis, such as chronic inflammation, immune activation, and some antiretroviral agents, are not taken into account in the available risk scores, leading to underestimation of cardiovascular risk in the HIV population. Cardiovascular prevention in HIV-infected patients is a challenge for both cardiologists and physicians involved in HIV care. We require new tools to assess this higher risk and studies to determine whether intensive primary prevention is warranted.
Collapse
Affiliation(s)
- Franck Boccara
- Department of Cardiology, Saint Antoine Hospital, University of Paris, Paris, France.
| | | | | | | | | | | | | | | |
Collapse
|
14
|
Ho JN, Yoon HG, Park CS, Kim S, Jun W, Choue R, Lee J. Isothiocyanates ameliorate the symptom of heart dysfunction and mortality in a murine AIDS model by inhibiting apoptosis in the left ventricle. J Med Food 2013; 15:781-7. [PMID: 22925072 DOI: 10.1089/jmf.2011.1906] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Cardiac involvement has been reported in as many as 45-55% of patients with human immunodeficiency virus (HIV) infection and acquired immune deficiency syndrome (AIDS), and significant cardiac morbidity is reported in 6-7% of HIV patients. We investigated the inhibitory effects of isothiocyanates (ITCs) on heart dysfunction and mortality by regulating apoptosis in the left ventricle of the heart in a murine AIDS model. Mice were divided into six groups: an uninfected group, an untreated LP-BM5 retrovirus-infected group, and four LP-BM5 retrovirus-infected groups treated with one of four ITCs (sulforaphane [SUL], indolo[3,2-b]carbazole, benzyl isothiocyanate [BITC], or phenethyl isothiocyanate [PEITC]). After 16 weeks, the median survival time of the LP-BM5 retrovirus-infected mice was 87 days, whereas that of the uninfected control group and all ITC treatment groups was over 112 days. SUL, PEITC, and BITC significantly inhibited apoptosis in the left ventricle by increasing the Bcl-2/Bax ratio compared with LP-BM5-infected mice. In addition, SUL and PEITC suppressed inducible nitric oxide synthase (iNOS) expression at both the mRNA and protein levels in the left ventricle of heart tissue infected with the LP-BM5 retrovirus by inactivating cytoplasmic nuclear factor κB (NF-κB). In conclusion, LP-BM5 retrovirus infection was related to survival of murine AIDS mice, and NF-κB-mediated iNOS expression may be an important mediator of left ventricle dysfunction of the heart. Furthermore, certain ITCs may have the potential to improve AIDS-related heart dysfunction due to their inhibition of apoptosis by decreasing iNOS and Bax expression through suppression of NF-κB.
Collapse
Affiliation(s)
- Jin-Nyoung Ho
- Research Institute of Clinical Nutrition, Department of Medical Nutrition, Kyung Hee University, Yongin, Korea
| | | | | | | | | | | | | |
Collapse
|
15
|
Fihn SD, Gardin JM, Abrams J, Berra K, Blankenship JC, Dallas AP, Douglas PS, Foody JM, Gerber TC, Hinderliter AL, King SB, Kligfield PD, Krumholz HM, Kwong RYK, Lim MJ, Linderbaum JA, Mack MJ, Munger MA, Prager RL, Sabik JF, Shaw LJ, Sikkema JD, Smith CR, Smith SC, Spertus JA, Williams SV. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: executive summary: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation 2012. [PMID: 23182125 DOI: 10.1016/j.jacc.2012.07.013] [Citation(s) in RCA: 1227] [Impact Index Per Article: 102.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
|
16
|
Fihn SD, Gardin JM, Abrams J, Berra K, Blankenship JC, Dallas AP, Douglas PS, Foody JM, Gerber TC, Hinderliter AL, King SB, Kligfield PD, Krumholz HM, Kwong RYK, Lim MJ, Linderbaum JA, Mack MJ, Munger MA, Prager RL, Sabik JF, Shaw LJ, Sikkema JD, Smith CR, Smith SC, Spertus JA, Williams SV, Anderson JL. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation 2012; 126:e354-471. [PMID: 23166211 DOI: 10.1161/cir.0b013e318277d6a0] [Citation(s) in RCA: 465] [Impact Index Per Article: 38.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
|
17
|
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.
Collapse
Affiliation(s)
- R Perelló
- Emergency Department, Barcelona, Spain.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Falcone EL, Mangili A, Skinner S, Alam A, Polak JF, Wanke CA. Framingham risk score and early markers of atherosclerosis in a cohort of adults infected with HIV. Antivir Ther 2011; 16:1-8. [PMID: 21311103 DOI: 10.3851/imp1682] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The utility of the Framingham risk score among individuals infected with HIV is poorly understood. We examined the association of Framingham risk scores with surrogate markers of atherosclerosis in a carefully characterized cohort of adults infected with HIV. METHODS We calculated Framingham risk scores and measured carotid intima-media thickness (c-IMT) and coronary artery calcium (CAC) scores in 334 participants from the Nutrition for Healthy Living study. Cardiovascular risk factors, c-IMT and CAC scores were assessed for each Framingham risk subgroup (low versus intermediate/high risk). We used adjusted and unadjusted linear and logistic regression to examine the association between clinical factors and Framingham risk group with c-IMT and CAC scores. RESULTS Patients with intermediate/high Framingham risk scores were more likely to have internal c-IMT ≥ 1.0 mm (26% versus 12%; P=0.003) and common c-IMT ≥ 0.8 mm (22% versus 5%; P < 0.001). These patients were also more likely to have detectable CAC (78% versus 48%; P < 0.001). Intermediate/high Framingham risk scores were significantly associated with internal c-IMT ≥ 1.0 mm (odds ratio 2.65 [95% confidence interval 1.37-5.13]) and common c-IMT ≥ 0.8 mm (odds ratio 5.24 [95% confidence interval 2.39-11.50]). Intermediate/high Framingham risk scores were also significantly associated with detectable CAC (odds ratio 3.84 [95% confidence interval 2.05-7.16]). The addition of HIV-related variables did not improve the accuracy of the Framingham risk score. CONCLUSIONS Our study shows that increased Framingham risk scores are associated with abnormal early and late surrogate markers of atherosclerosis in adults infected with HIV, and might predict the risk of cardiovascular complications in this population.
Collapse
Affiliation(s)
- E Liana Falcone
- Department of Medicine, Tufts Medical Center, Boston, MA, USA.
| | | | | | | | | | | |
Collapse
|
19
|
Hendel RC, Abbott BG, Bateman TM, Blankstein R, Calnon DA, Leppo JA, Maddahi J, Schumaecker MM, Shaw LJ, Ward RP, Wolinsky DG. The role of radionuclide myocardial perfusion imaging for asymptomatic individuals. J Nucl Cardiol 2011; 18:3-15. [PMID: 21181519 DOI: 10.1007/s12350-010-9320-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Robert C Hendel
- University of Miami Miller School of Medicine, Miami, FL, USA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Lytwyn M, Fallah-Rad N, Walker J, Bohonis S, Hussain F, Barac I, Jassal DS. The Utility of Dobutamine Stress Echocardiography for the Diagnosis of Coronary Artery Disease in the HIV Population. Echocardiography 2010; 27:1228-32. [DOI: 10.1111/j.1540-8175.2010.01218.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
21
|
Abstract
The aspects of cardiovascular disease in the patient infected with HIV that are of particular relevance to the emergency physician, including coronary artery disease and acute coronary syndromes, pericardial disease, and dilated cardiomyopathy are discussed in this review.
Collapse
Affiliation(s)
- Rakesh K Mishra
- Berkeley Cardiovascular Medical Group, 2450 Ashby Avenue, Berkeley, CA 94705, USA.
| |
Collapse
|
22
|
|
23
|
Abstract
The advent of highly active antiretroviral therapy has led to a significant decline in the incidence of mortality and progression to AIDS in HIV-infection. With increased life expectancy, HIV-infected individuals are being affected by cardiovascular disease. Research studies have identified an increased prevalence of traditional coronary risk factors in HIV-infected patients. Additional investigations suggest that the virus itself may independently result in atherosclerosis. Further studies have linked the use of highly active antiretroviral therapy to the atherosclerotic processes. These findings suggest the need to reconsider HIV as one of the traditionally accepted risk factors for coronary artery disease, with treatment aimed at prevention of myocardial infarction.
Collapse
|
24
|
Khunnawat C, Mukerji S, Havlichek D, Touma R, Abela GS. Cardiovascular manifestations in human immunodeficiency virus-infected patients. Am J Cardiol 2008; 102:635-42. [PMID: 18721528 DOI: 10.1016/j.amjcard.2008.04.035] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2008] [Revised: 04/17/2008] [Accepted: 04/17/2008] [Indexed: 10/21/2022]
Abstract
Human immunodeficiency virus (HIV) is now a pandemic. It afflicts multiple organs, including the cardiovascular system. This occurs by direct invasion as well as opportunistic infections complicating acquired immunodeficiency syndrome. The presence of newer highly active antiretroviral therapy has led to longer survival of patients infected with HIV, but the cardiac abnormalities related to HIV have remained less well characterized. It is now evident that cardiac involvement in patients with acquired immunodeficiency syndrome is relatively common. This includes coronary artery disease, dilated cardiomyopathy, pericardial effusion, pulmonary hypertension, and ill effects of highly active antiretroviral therapy in the form of lipodystrophy, lipoatrophy, and dyslipidemia. In fact, HIV can now be viewed as a potential risk factor for coronary artery disease, and the dilemma facing clinicians is how to quantify this risk. Awareness of accelerated coronary artery disease and dilated cardiomyopathy is critical to implement preventive measures early in the course of HIV. However, better guidelines are still needed on the basis of prospective randomized controlled studies involving large populations. In conclusion, this review describes cardiac abnormalities associated with HIV, including possible molecular mechanisms. The co-morbid sequelae, their presentation, and pharmacologic management are also discussed.
Collapse
|
25
|
Cardiovascular Involvement in Acquired Immune Deficiency Syndrome. CARDIOVASCULAR MEDICINE 2007. [DOI: 10.1007/978-1-84628-715-2_114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
|
26
|
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
|
27
|
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.
Collapse
Affiliation(s)
- Carlos S Restrepo
- Department of Radiology, Louisiana State University Health Sciences Center, 1542 Tulane Ave, Room 212, New Orleans, LA 70112, USA.
| | | | | | | | | | | | | | | |
Collapse
|
28
|
Abstract
Patient case:
A 48-year-old man with human immunodeficiency virus (HIV) infection developed chronic chest pain that started after a bout of pneumonia. He has hypertension and has smoked cigarettes in the past. His current medications include Kaletra and Combivir. His total cholesterol was 331 mg/L, his HDL cholesterol was 27 mg/L, his triglycerides were 935 mg/L, and his LDL cholesterol could not be calculated. How should this patient be evaluated and managed?
Collapse
Affiliation(s)
- Priscilla Y Hsue
- Division of Cardiology, San Francisco General Hospital, Department of Medicine, University of California, San Francisco, CA, USA
| | | |
Collapse
|
29
|
Hsue PY, Giri K, Erickson S, MacGregor JS, Younes N, Shergill A, Waters DD. Clinical features of acute coronary syndromes in patients with human immunodeficiency virus infection. Circulation 2004; 109:316-9. [PMID: 14718406 DOI: 10.1161/01.cir.0000114520.38748.aa] [Citation(s) in RCA: 155] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patients with HIV infection exhibit increased rates of coronary events; however, the clinical features of acute coronary syndromes (ACS) in HIV-infected patients have not been well defined. METHODS AND RESULTS Between 1993 and 2003, 68 HIV-infected patients were hospitalized with ACS. We compared the clinical features and outcome of these patients with those of 68 randomly selected control patients with ACS without HIV. HIV patients were on average more than a decade younger than controls and more likely to be male and current smokers and to have low HDL cholesterol. They were less likely than controls to have diabetes or hyperlipidemia, and their TIMI (Thrombolysis In Myocardial Infarction) risk scores on admission were significantly lower. At coronary angiography, the number of vessels with >50% stenosis was 1.3+/-1.0 in HIV patients and 1.9+/-1.2 in controls (P=0.007). Restenosis developed in 15 of 29 HIV patients who underwent percutaneous coronary intervention compared with 3 of 21 controls (52% versus 14%, P=0.006). CONCLUSIONS HIV patients with ACS are younger and more likely to be males and current smokers and to have low HDL cholesterol levels compared with other ACS patients. Their TIMI risk scores are lower, and they are more likely to have single-vessel disease; however, their restenosis rates after percutaneous coronary intervention are unexpectedly high.
Collapse
Affiliation(s)
- Priscilla Y Hsue
- Room 5G1, Division of Cardiology, San Francisco General Hospital, 1001 Potrero Ave, San Francisco, CA 94110.
| | | | | | | | | | | | | |
Collapse
|
30
|
Gowda RM, Khan IA, Mehta NJ, Gowda MR, Sacchi TJ, Vasavada BC. Cardiac tamponade in patients with human immunodeficiency virus disease. Angiology 2003; 54:469-74. [PMID: 12934767 DOI: 10.1177/000331970305400411] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The characteristics of cardiac tamponade in patients with human immunodeficiency virus (HIV) disease were examined by evaluating the cases, case series, and related articles, including autopsy series, identified through a comprehensive literature search. One-hundred eighty-five cases of cardiac tamponade have been reported in patients with HIV disease. Sex data were available in 176 patients, of whom 154 (87%) were males. The mean age was 34.7 +/- 10.4 years (range, 11 months to 61 years). Mean CD4 cell count was 98 +/- 95 cells/mm3 (range, 3 to 430 cells/mm3). The most common etiology of pericardial tamponade was mycobacterial infection (78 patients), including Mycobacterium tuberculosis, Mycobacterium avium-intracellulare, and Mycobacterium kansasii. A bacterial cause was found in 20 patients (11%). Staphylococcus aureus was the predominant bacteria, followed by streptococci, Pseudomonas aeruginosa, Listeria monocytogenes, Klebsiella pneumoniae, and Rhodococcus equi. Lymphoma was found in 15 (8%) patients and Kaposi sarcoma in 13 (7%) patients. Numerous unusual organisms, including Cryptococcus neoformans, Nocardia asteroides, Aspergillus species, cytomegalovirus, and herpes simplex were also associated with cardiac tamponade in HIV patients. Occasionally, HIV itself was involved in the pathogenesis. In 48 patients (26%), no cause was found or reported. The most common clinical presentation was dyspnea, followed by fever, cough, chest pain, and cardiac arrest. The predominant pericardial fluid color composition was serosanguineous. The majority of patients died during hospitalization or in the immediate follow-up period. Vigilance for cardiac tamponade in patients with HIV disease, especially in those with opportunistic infections and/or malignancies, and cardiac symptoms, may result in early and proper management of cardiac tamponade in these patients.
Collapse
Affiliation(s)
- Ramesh M Gowda
- Division of Cardiology, Long Island College Hospital, Brooklyn, NY, USA
| | | | | | | | | | | |
Collapse
|