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Ogyefo IN, Obese V, Norman BR, Owusu IK, Nkum B, Kokuro C. Prevalence and patterns of echocardiographic abnormalities among people living with HIV on anti-retroviral therapy in Kumasi, Ghana. BMC Cardiovasc Disord 2024; 24:453. [PMID: 39192179 DOI: 10.1186/s12872-024-04117-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 08/13/2024] [Indexed: 08/29/2024] Open
Abstract
BACKGROUND Echocardiography can be used to screen, confirm, and assist in the management of some cardiovascular diseases in people living with human immunodeficiency virus (HIV) (PLWH). Thus, complications from subclinical cardiovascular conditions or more apparent conditions, such as massive pericardial effusion with tamponade, can be promptly identified and managed to minimize cardiovascular morbidity and mortality associated with HIV infection. Since the introduction of antiretroviral therapy (ART) in Ghana approximately two decades ago, studies on the prevalence and patterns of echocardiographic abnormalities among PLWH on ART have been limited. This study was designed to assess the prevalence and patterns of echocardiographic abnormalities among PLWH on ART. METHODS This was a cross-sectional study. PLWH on ART (cases) attending the HIV clinic at Komfo Anokye Teaching Hospital (KATH) and HIV-negative blood donors (controls) were consecutively recruited and enrolled in this study. The interviews were performed via a standardized questionnaire. After a clinical examination was performed, all patients underwent two-dimensional (2D) and Doppler transthoracic echocardiograms. The prevalence and patterns of echocardiographic abnormalities were characterized. RESULTS There were 117 patients in each arm of the study. There were more females than males among both the cases (92 (78.6%) and controls (80 (68.4%)); however, the sex distribution was similar between the two groups (p = 0.075). For clinical characteristics such as age, weight, height and blood pressure, there were no statistically significant differences between the cases and controls. Echocardiographic abnormalities were more frequently observed and demonstrated a statistically significant difference between cases and controls, with an overall prevalence of 35.0% among cases and 19.7% among controls (p = 0.008). The echocardiographic abnormalities that demonstrated significant differences between the cases and controls were left ventricular (LV) diastolic dysfunction (28.2% versus 8.6%; p = 0.000) and LV hypertrophy (7% versus 0.9%; p = 0.017). CONCLUSION Nearly 1 in 3 PLWH on ART had an echocardiographic abnormality in this Ghanaian study. Echocardiograms are recommended as helpful screening modalities for diagnosing cardiac abnormalities among PLWH on ART.
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Affiliation(s)
- Isaac Nana Ogyefo
- Department of Medicine, School of Medicine and Dentistry, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
- Komfo Anokye Teaching Hospital, Kumasi, Ghana.
| | - Vida Obese
- Department of Medicine, School of Medicine and Dentistry, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Betty Roberta Norman
- Department of Medicine, School of Medicine and Dentistry, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Isaac Kofi Owusu
- Department of Medicine, School of Medicine and Dentistry, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Bernard Nkum
- Department of Medicine, School of Medicine and Dentistry, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Collins Kokuro
- Department of Medicine, School of Medicine and Dentistry, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Komfo Anokye Teaching Hospital, Kumasi, Ghana
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Bajdechi M, Gurghean A, Bataila V, Scafa-Udriște A, Bajdechi GE, Radoi R, Oprea AC, Chioncel V, Mateescu I, Zekra L, Cernat R, Dumitru IM, Rugina S. Particular Aspects Related to CD4+ Level in a Group of HIV-Infected Patients and Associated Acute Coronary Syndrome. Diagnostics (Basel) 2023; 13:2682. [PMID: 37627941 PMCID: PMC10453880 DOI: 10.3390/diagnostics13162682] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/11/2023] [Accepted: 08/13/2023] [Indexed: 08/27/2023] Open
Abstract
People living with HIV infection are at high risk for cardiovascular events due to inflammation and atherosclerosis. Also, some antiretroviral therapies may contribute to the risk of cardiovascular complications. Immune status is highly dependent on the level of lymphocyte T helper CD4+. There are data suggesting that immune status and CD4+ cell count may be involved in the development of cardiovascular complications in these patients. Our study is longitudinal and retrospective and included a total number of 50 patients with HIV infection associated with acute coronary syndrome, divided into two subgroups based on the nadir of CD4+ cells. This study analyzes the relationship between the immune status of HIV patients, assessed by the nadir of the CD4+ T-cell count, and the outcome of these patients. Also, secondary endpoints were the assessment of the magnitude of coronary lesions and of thrombotic and bleeding risk assessed by specific scores. Clinical and biological parameters and also the extension and complexity of coronary lesions were assessed. Although patients with poor immune status had more complex coronary lesions and increased operative risk and bleeding risk at one year, this was not associated with significant differences in major adverse cardiac and cerebrovascular events at the 30-day and 1-year outcomes.
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Affiliation(s)
- Mircea Bajdechi
- Faculty of Medicine, University of Medicine and Pharmacy “Carol Davila” of Bucharest, 050474 Bucharest, Romania; (M.B.); (A.S.-U.); (G.-E.B.); (A.C.O.); (V.C.); (I.M.)
- Doctoral School of Medicine, “Ovidius” University of Constanta, 900470 Constanta, Romania; (L.Z.); (R.C.); (I.M.D.); (S.R.)
| | - Adriana Gurghean
- Faculty of Medicine, University of Medicine and Pharmacy “Carol Davila” of Bucharest, 050474 Bucharest, Romania; (M.B.); (A.S.-U.); (G.-E.B.); (A.C.O.); (V.C.); (I.M.)
| | - Vlad Bataila
- Emergency Clinical Hospital of Bucharest, 014461 Bucharest, Romania
| | - Alexandru Scafa-Udriște
- Faculty of Medicine, University of Medicine and Pharmacy “Carol Davila” of Bucharest, 050474 Bucharest, Romania; (M.B.); (A.S.-U.); (G.-E.B.); (A.C.O.); (V.C.); (I.M.)
- Emergency Clinical Hospital of Bucharest, 014461 Bucharest, Romania
| | - Georgiana-Elena Bajdechi
- Faculty of Medicine, University of Medicine and Pharmacy “Carol Davila” of Bucharest, 050474 Bucharest, Romania; (M.B.); (A.S.-U.); (G.-E.B.); (A.C.O.); (V.C.); (I.M.)
| | - Roxana Radoi
- Clinical Hospital of Infectious and Tropical Disease “Dr. Victor Babes” of Bucharest, 030303 Bucharest, Romania;
| | - Anca Cristiana Oprea
- Faculty of Medicine, University of Medicine and Pharmacy “Carol Davila” of Bucharest, 050474 Bucharest, Romania; (M.B.); (A.S.-U.); (G.-E.B.); (A.C.O.); (V.C.); (I.M.)
- Clinical Hospital of Infectious and Tropical Disease “Dr. Victor Babes” of Bucharest, 030303 Bucharest, Romania;
| | - Valentin Chioncel
- Faculty of Medicine, University of Medicine and Pharmacy “Carol Davila” of Bucharest, 050474 Bucharest, Romania; (M.B.); (A.S.-U.); (G.-E.B.); (A.C.O.); (V.C.); (I.M.)
| | - Iuliana Mateescu
- Faculty of Medicine, University of Medicine and Pharmacy “Carol Davila” of Bucharest, 050474 Bucharest, Romania; (M.B.); (A.S.-U.); (G.-E.B.); (A.C.O.); (V.C.); (I.M.)
| | - Lucia Zekra
- Doctoral School of Medicine, “Ovidius” University of Constanta, 900470 Constanta, Romania; (L.Z.); (R.C.); (I.M.D.); (S.R.)
- Clinical Infectious Disease Hospital of Constanta, 900178 Constanta, Romania
| | - Roxana Cernat
- Doctoral School of Medicine, “Ovidius” University of Constanta, 900470 Constanta, Romania; (L.Z.); (R.C.); (I.M.D.); (S.R.)
- Clinical Infectious Disease Hospital of Constanta, 900178 Constanta, Romania
| | - Irina Magdalena Dumitru
- Doctoral School of Medicine, “Ovidius” University of Constanta, 900470 Constanta, Romania; (L.Z.); (R.C.); (I.M.D.); (S.R.)
- Clinical Infectious Disease Hospital of Constanta, 900178 Constanta, Romania
| | - Sorin Rugina
- Doctoral School of Medicine, “Ovidius” University of Constanta, 900470 Constanta, Romania; (L.Z.); (R.C.); (I.M.D.); (S.R.)
- Clinical Infectious Disease Hospital of Constanta, 900178 Constanta, Romania
- Romanian Academy of Medical Sciences, 030167 Bucharest, Romania
- Academy of Romanian Scientists, 050045 Bucharest, Romania
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Kumar P, Arendt C, Martin S, Al Soufi S, DeLeuw P, Nagel E, Puntmann VO. Multimodality Imaging in HIV-Associated Cardiovascular Complications: A Comprehensive Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2201. [PMID: 36767567 PMCID: PMC9915416 DOI: 10.3390/ijerph20032201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/17/2023] [Accepted: 01/20/2023] [Indexed: 06/18/2023]
Abstract
Human immunodeficiency virus (HIV) infection is a leading cause of mortality and morbidity worldwide. The introduction of antiretroviral therapy (ART) has significantly reduced the risk of developing acquired immune deficiency syndrome and increased life expectancy, approaching that of the general population. However, people living with HIV have a substantially increased risk of cardiovascular diseases despite long-term viral suppression using ART. HIV-associated cardiovascular complications encompass a broad spectrum of diseases that involve the myocardium, pericardium, coronary arteries, valves, and systemic and pulmonary vasculature. Traditional risk stratification tools do not accurately predict cardiovascular risk in this population. Multimodality imaging plays an essential role in the evaluation of various HIV-related cardiovascular complications. Here, we emphasize the role of multimodality imaging in establishing the diagnosis and aetiopathogenesis of various cardiovascular manifestations related to chronic HIV disease. This review also provides a critical appraisal of contemporary data and illustrative cases.
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Affiliation(s)
- Parveen Kumar
- Institute of Experimental and Translational Cardiac Imaging, DZHK, Centre for Cardiovascular Imaging, University Hospital Frankfurt, 60590 Frankfurt am Main, Germany
| | - Christophe Arendt
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60590 Frankfurt am Main, Germany
| | - Simon Martin
- Institute of Experimental and Translational Cardiac Imaging, DZHK, Centre for Cardiovascular Imaging, University Hospital Frankfurt, 60590 Frankfurt am Main, Germany
| | - Safaa Al Soufi
- Institute of Experimental and Translational Cardiac Imaging, DZHK, Centre for Cardiovascular Imaging, University Hospital Frankfurt, 60590 Frankfurt am Main, Germany
| | | | - Eike Nagel
- Institute of Experimental and Translational Cardiac Imaging, DZHK, Centre for Cardiovascular Imaging, University Hospital Frankfurt, 60590 Frankfurt am Main, Germany
| | - Valentina O. Puntmann
- Institute of Experimental and Translational Cardiac Imaging, DZHK, Centre for Cardiovascular Imaging, University Hospital Frankfurt, 60590 Frankfurt am Main, Germany
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Abbasi F, Alexander A, Korooni Fardkhani S, Iranpour D, Mirzaei K, Kalantarhormozi M, Haghighi M, Bagheri M. Evaluation of HIV-Related Cardiomyopathy in HIV-Positive Patients in Bushehr, Iran. Cureus 2022; 14:e28078. [PMID: 36127962 PMCID: PMC9477548 DOI: 10.7759/cureus.28078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2022] [Indexed: 12/03/2022] Open
Abstract
Objectives In 2020, according to the UNAIDS (Joint United Nations Programme on HIV/AIDS), more than 37 million people lived with human immunodeficiency virus (HIV) infection worldwide. The disease is known to affect several organs, and one of the most affected organs is the heart. Cardiac diseases are highly prevalent among HIV-infected individuals, and recent findings suggest that this could be due to the damage caused by the virus. HIV patients are subject to advanced immunosuppression, which may lead to cardiac muscle damage and, in turn, cardiomyopathy. We aimed to study the incidence of HIV-related cardiomyopathy. Methods A pilot cross-sectional study was conducted to assess cardiomyopathy among 200 HIV patients who presented to the Heart Center, Bushehr, Iran. Patients’ files were used to determine the demographic data including age, gender, education, marital status, history of illicit drug use, unsafe/unprotected sexual contact, and whether the patient was a prisoner. Several laboratory data were also collected from these files. Physical examination of the cardiovascular system and echocardiography were also included as part of the evaluation. Results Although at least four out of five patients presented with some kind of cardiac damage, including valvular damage and pericardial effusion, none was diagnosed with cardiomyopathy. Valvular dysfunction was detected in 88.5% of the patients. Diastolic dysfunction was found in 7.7% of them. The mean ejection fraction was found to be 58%. In addition to cardiomyopathy, none of the patients developed systolic dysfunction, wall motion abnormality, intra-cardiac mass, or vegetation. Conclusions Cardiovascular complications are common among HIV-infected patients. Cardiomyopathy was not detected in our patients. In addition, the most common manifestations that were detected among our patients were valvular heart diseases and pericardial effusion.
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Gonçalves AJ, Braga MVA, Santana PH, Resende LAPR, da Silva VJD, Correia D. Linear and non-linear analysis of heart rate variability in HIV-positive patients on two different antiretroviral therapy regimens. BMC Infect Dis 2021; 21:1022. [PMID: 34587909 PMCID: PMC8482565 DOI: 10.1186/s12879-021-06648-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 08/03/2021] [Indexed: 12/23/2022] Open
Abstract
Background Cardiac autonomic dysfunction in HIV+ patients on different antiretroviral therapy (ART) regimens has been described. We aimed to characterize parameters of heart rate variability (HRV) and correlate with different classes of ART in HIV+ patients in three experimental conditions: rest, cold face, and tilt tests. Methods Cross-sectional study with three groups of age- and gender-matched individuals: group 1, 44 HIV+ patients undergoing combination therapy, with two nucleoside reverse transcriptase inhibitors (NRTI) and one non-nucleoside reverse transcriptase inhibitor (NNRTI); group 2, 42 HIV+ patients using two NRTI and protease inhibitors (PI’s); and group 3, 35 healthy volunteers with negative HIV serology (control group). Autonomic function at rest and during cold face- and tilt-tests was assessed through computerized analysis of HRV, via quantification of time- and frequency domains by linear and non-linear parameters in the three groups. Results Anthropometric and clinical parameters were similar between both HIV groups, except CD4+ T lymphocytes, which were significantly lower in group 2 (p = 0.039). At baseline, time-domain linear HRV parameters, RMSSD and pNN50, and the correlation dimension, a non-linear HRV parameter (p < 0.001; p = 0.018; p = 0.019, respectively), as well as response of RMSSD to cold face test were also lower in the HIV+ group than in the control individuals (p < 0.001), while no differences among groups were detected in HRV parameters during the tilt test. Conclusions Despite ART regimens, HIV+ patients presented lower cardiac vagal modulation than controls, whereas no difference was observed among the HIV groups, suggesting that higher cardiovascular risk linked to PIs may be associated with factors other than autonomic dysfunction.
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Affiliation(s)
- Anderson José Gonçalves
- Infectious Diseases Division, Internal Medicine Department, Federal University of the Triângulo Mineiro, Av. Getúlio Guaritá, 430, Bairro Nossa Senhora da Abadia, PO Box: 118, Uberaba, Minas Gerais State, CEP: 38025-350, Brazil
| | | | | | | | - Valdo José Dias da Silva
- Physiology Division, Biological Science Department, Federal University of the Triângulo Mineiro, Uberaba, Minas Gerais State, Brazil
| | - Dalmo Correia
- Infectious Diseases Division, Internal Medicine Department, Federal University of the Triângulo Mineiro, Av. Getúlio Guaritá, 430, Bairro Nossa Senhora da Abadia, PO Box: 118, Uberaba, Minas Gerais State, CEP: 38025-350, Brazil.
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Ursache A, Tibeica AM, Luca A, Onofriescu M, Matasariu DR, Nemescu D. Fetal cardiac evaluation in HIV-positive women under HAART therapy in a Romanian hospital. Exp Ther Med 2021; 21:606. [PMID: 33936263 PMCID: PMC8082575 DOI: 10.3892/etm.2021.10038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 01/05/2021] [Indexed: 11/06/2022] Open
Abstract
Human immunodeficiency virus (HIV) is an RNA (ribonucleic acid) virus that causes acquired immunodeficiency syndrome (AIDS). This disease has a major socioeconomical impact. The aim of the present study was to assess the fetal heart structure and function in HIV-positive pregnant women on highly active antiretroviral therapy (HAART). This is a prospective study conducted between January, 2018 and December, 2019. The hearts of fetuses from 14 HIV-positive pregnant women on HAART were assessed. Statistically significant sex-related cardiac changes in HIV-exposed uninfected fetuses of pregnant women on HAART were found. A narrow aorta was detected in female fetuses and a smaller left ventricular transverse diameter in male fetuses. Overall, the myocardial performance index remained unaltered. The impact of antiretroviral therapy on fetal heart seems to be sex-related. Accurate and complete information about the risks and benefits of antiretroviral treatment and management strategies to improve fetal outcomes may also ensure better compliance of the mothers to this treatment.
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Affiliation(s)
- Alexandra Ursache
- Department of Obstetrics and Gynecology, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Alexandra Maria Tibeica
- Department of Obstetrics 'Cuza Voda' Obstetrics and Gynecology Clinical Hospital, 700038 Iasi, Romania
| | - Alexandru Luca
- Department of Obstetrics 'Cuza Voda' Obstetrics and Gynecology Clinical Hospital, 700038 Iasi, Romania
| | - Mircea Onofriescu
- Department of Obstetrics and Gynecology, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania.,Department of Obstetrics 'Cuza Voda' Obstetrics and Gynecology Clinical Hospital, 700038 Iasi, Romania
| | - Daniela Roxana Matasariu
- Department of Obstetrics and Gynecology, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Dragos Nemescu
- Department of Obstetrics and Gynecology, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania.,Department of Obstetrics 'Cuza Voda' Obstetrics and Gynecology Clinical Hospital, 700038 Iasi, Romania
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Ashwitha SK, Jacob PA, Ajaj A, Shirke MM, Harky A. Management of cardiovascular diseases in HIV/AIDS patients. J Card Surg 2020; 36:236-243. [PMID: 33225472 DOI: 10.1111/jocs.15213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 11/09/2020] [Indexed: 11/30/2022]
Abstract
Human immunodeficiency virus (HIV) infection/acquired immunodeficiency syndrome, a pandemic in the current population causes severe weakness of the body's immune system making the infected patient more vulnerable to life-threatening conditions. The disease predisposes the infected patient to several cardiovascular diseases and cerebrovascular diseases such as heart failure and stroke. The decline in CD4 cells following HIV infection, vulnerability to opportunistic infections and underlying HIV pathology plays a major role in the development of cardiovascular manifestations, and treatment targeting cardiomyopathy in this specific patient subset is not well recognized. Patients living with HIV (PLWH) also experience discrimination in receiving cardiovascular disease care and this needs to be addressed by strengthening frameworks for monitoring and providing nonjudgmental healthcare. This review aims to study the profile of the cardiovascular disease in HIV patients, treatment, and provide evidence of the disparity in the provision of healthcare with regard to PLWH.
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Affiliation(s)
- Santoshi K Ashwitha
- Department of Medicine, School of Medicine, Queen's University Belfast, Belfast, UK
| | - Preethi A Jacob
- Department of Medicine, School of Medicine, Queen's University Belfast, Belfast, UK
| | - Abdullah Ajaj
- Department of Medicine, School of Medicine, Queen's University Belfast, Belfast, UK
| | - Manasi M Shirke
- Department of Medicine, School of Medicine, Queen's University Belfast, Belfast, UK
| | - Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK.,Liverpool Heart and Chest Hospital, Department of Cardiovascular Science, University of Liverpool, Liverpool, UK.,Department of Cardiac Surgery, Alder Hey Children Hospital, Liverpool, UK
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Piñeirua-Menéndez A, Flores-Miranda R, Sánchez-Nava D, Ortega-Pérez R, Belaunzaran-Zamudio PF, Pérez-Patrigeon S, Cárdenas-Ochoa A, Oseguera-Moguel J, Galindo-Uribe J, Orihuela-Sandoval C, Vázquez-Ortiz Z, Vázquez-Lamadrid J, Morelos-Guzmán M, Rosales-Uvera S, Crabtree-Ramírez B, Sierra-Madero J. Myocardial Inflammatory Changes Before and After Antiretroviral Therapy Initiation in People With Advanced Human Immunodeficiency Virus Disease. Open Forum Infect Dis 2020; 7:ofaa297. [PMID: 32818141 PMCID: PMC7423298 DOI: 10.1093/ofid/ofaa297] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 07/24/2020] [Indexed: 11/12/2022] Open
Abstract
Because of the high frequency of late presentation of human immunodeficiency virus (HIV) disease in our population, we decided to explore the presence of myocarditis among people with HIV infection and advanced immunosuppression (less than 200 CD4+ cells/μL) and to describe the inflammatory changes observed after combined antiretroviral therapy initiation in an observational, longitudinal, prospective cohort. We performed both cardiovascular magnetic resonance imaging and doppler transthoracic echocardiogram.
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Affiliation(s)
- A Piñeirua-Menéndez
- Centro Nacional para la Prevención y Control del VIH y del SIDA, Ciudad de México
| | - R Flores-Miranda
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Departamento de Medicina Interna, Ciudad de México
| | - D Sánchez-Nava
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Departamento de Imagenología, Ciudad de México
| | - R Ortega-Pérez
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Departamento de Medicina Interna, Ciudad de México
| | - P F Belaunzaran-Zamudio
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Departamento de Infectología, Ciudad de México
| | - S Pérez-Patrigeon
- Division of Infectious Diseases, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - A Cárdenas-Ochoa
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Departamento de Infectología, Ciudad de México
| | - J Oseguera-Moguel
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Departamento de Cardiología, Ciudad de México
| | - J Galindo-Uribe
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Departamento de Cardiología, Ciudad de México
| | - C Orihuela-Sandoval
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Departamento de Cardiología, Ciudad de México
| | - Z Vázquez-Ortiz
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Departamento de Cardiología, Ciudad de México
| | - Jorge Vázquez-Lamadrid
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Departamento de Imagenología, Ciudad de México
| | - M Morelos-Guzmán
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Departamento de Imagenología, Ciudad de México
| | - S Rosales-Uvera
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Departamento de Imagenología, Ciudad de México
| | - B Crabtree-Ramírez
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Departamento de Infectología, Ciudad de México
| | - J Sierra-Madero
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Departamento de Infectología, Ciudad de México
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9
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Lawal IO, Stoltz AC, Sathekge MM. Molecular imaging of cardiovascular inflammation and infection in people living with HIV infection. Clin Transl Imaging 2020. [DOI: 10.1007/s40336-020-00370-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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10
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Rodrigues RC, de Azevedo KML, Moscavitch SD, Setubal S, Mesquita CT. The Use of Two-Dimensional Strain Measured by Speckle Tracking in the Identification of Incipient Ventricular Dysfunction in HIV-Infected Patients on Antiretroviral Therapy, Untreated HIV Patients and Healthy Controls. Arq Bras Cardiol 2019; 113:737-745. [PMID: 31482986 PMCID: PMC7020862 DOI: 10.5935/abc.20190169] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 03/07/2019] [Accepted: 03/12/2019] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Most cardiovascular abnormalities in patients infected with the human immunodeficiency virus (HIV) have been associated with myocardial damage directly caused by the virus. Some cases, however, may be associated with adverse effects from antiretroviral therapy (ART). New ventricular function assessment techniques are capable of detecting early changes in the cardiac function of HIV-infected patients using or not using ART. The usefulness of these techniques has been little employed in these patients. OBJECTIVES To investigate the potential influence of antiretroviral therapy (ART) on the occurrence of subclinical left ventricular systolic dysfunction evaluated by myocardial strain rate analysis using two-dimensional speckle tracking echocardiography (2-D Echo) in treated HIV patients compared to untreated patients and healthy individuals. METHODS Sixty-eight HIV-infected patients with no cardiovascular symptoms, normal left ventricular (LV) ejection fraction (> 0.55 on 2-D Echo) were divided into three groups: 11 patients not using antiretroviral therapy (NT), 24 using protease inhibitor (PI) and 33 using non-nucleoside reverse transcriptase inhibitor (NNRTI). We also studied 30 normal non-HIV infected individuals (Ctrl). Demographic, clinical, biochemical and anthropometric data were collected. Preliminary transthoracic echocardiography included study of myocardial strain using two-dimensional speckle tracking. We studied strain and strain rate in the seventeen left ventricular (LV) myocardial segments in the longitudinal, circumferential and radial axes. Statistical analysis of the data was done with IBM SPSS - version 20 for Windows. Upon analysis of the data, namely the normality of independent variables in the different groups and the homogeneity of the variances between the groups, Kruskal-Wallis' non-parametric test was done, followed by Dunn's multiple comparison tests to test the significance of the differences between the values measured in the study groups. A significance level of 5% was adopted for decision-making on statistical tests. RESULTS The mean age of HIV patients was 40 ± 8.65 years and the mean age of controls was 50 ± 11.6 years (p < 0.001). Median LV global longitudinal strain (GLS) of NT patients (-17.70%), PI patients (-18.27%) and NNRTIs (-18.47%) were significantly lower than that of the Ctrl group (-20.77%; p = 0.001). There was no significant difference in mean SLG between treated patients (PI, NNRTI) and untreated (NT) patients. No significant differences were observed in mean circumferential and radial strain, nor on circumferential and radial strain rates between the NT, PI, NNRTI and Ctrl groups. CONCLUSION The data suggest that HIV patients present, on myocardial strain measured by speckle tracking, signs of early LV systolic dysfunction that seem to be unrelated to the presence of ART. The prognostic significance of this condition in these patients deserves further studies.
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Affiliation(s)
| | | | | | - Sergio Setubal
- Universidade Federal Fluminense (UFF), Niterói, RJ - Brazil
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11
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Abstract
: Neurological conditions associated with HIV remain major contributors to morbidity and mortality and are increasingly recognized in the aging population on long-standing combination antiretroviral therapy (cART). Importantly, growing evidence shows that the central nervous system (CNS) may serve as a reservoir for viral replication, which has major implications for HIV eradication strategies. Although there has been major progress in the last decade in our understanding of the pathogenesis, burden, and impact of neurological conditions associated with HIV infection, significant scientific gaps remain. In many resource-limited settings, antiretrovirals considered second or third line in the United States, which carry substantial neurotoxicity, remain mainstays of treatment, and patients continue to present with severe immunosuppression and CNS opportunistic infections. Despite this, increased global access to cART has coincided with an aging HIV-positive population with cognitive sequelae, cerebrovascular disease, and peripheral neuropathy. Further neurological research in low-income and middle-income countries (LMICs) is needed to address the burden of neurological complications in HIV-positive patients, particularly regarding CNS viral reservoirs and their effects on eradication.
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12
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Lima MAC, Cunha GHD, Galvão MTG, Rocha RP, Franco KB, Fontenele MSM. Systemic Arterial Hypertension in people living with HIV/AIDS: integrative review. Rev Bras Enferm 2018; 70:1309-1317. [PMID: 29160495 DOI: 10.1590/0034-7167-2016-0416] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 01/04/2017] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To analyze scientific productions about the relationship between HIV and Systemic Arterial Hypertension (SAH) in people living with HIV/AIDS (PLWHA). METHOD Integrative literature review in six databases, held in March 2016. "AIDS" and "hypertension" were the keywords used in Portuguese, English and Spanish languages. We found 248 articles and selected 17. The categories formulated were "prevalence of SAH in PLWHA," "risk factors for SAH in PLWHA" and "adverse events of antiretroviral therapy (ART) that contribute to HAS." RESULTS There is no consensus whether HIV and ART influence the SAH development, but there are several risk factors for SAH among PLWHA. It was observed that protease inhibitors medicines influence SAH the most. CONCLUSION Guidelines for SAH prevention must be performed in all individuals, however, in PLWHA, they must focus on characteristic risk factors of this population.
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Affiliation(s)
- Maria Amanda Correia Lima
- Universidade Federal do Ceará, Department of Nursing, Health Care Research Group on HIV/AIDS and Chronic Conditions. Fortaleza, Ceará, Brazil
| | - Gilmara Holanda da Cunha
- Universidade Federal do Ceará, Department of Nursing, Health Care Research Group on HIV/AIDS and Chronic Conditions. Fortaleza, Ceará, Brazil.,Universidade Federal do Ceará, Department of Nursing, Research Group and Center of Studies on HIV/AIDS and Associated Diseases. Fortaleza, Ceará, Brazil
| | - Marli Teresinha Gimeniz Galvão
- Universidade Federal do Ceará, Department of Nursing, Research Group and Center of Studies on HIV/AIDS and Associated Diseases. Fortaleza, Ceará, Brazil
| | - Ryvanne Paulino Rocha
- Universidade Federal do Ceará, Department of Nursing, Health Care Research Group on HIV/AIDS and Chronic Conditions. Fortaleza, Ceará, Brazil
| | - Kátia Barbosa Franco
- Universidade Federal do Ceará, Department of Nursing, Health Care Research Group on HIV/AIDS and Chronic Conditions. Fortaleza, Ceará, Brazil
| | - Marina Soares Monteiro Fontenele
- Universidade Federal do Ceará, Department of Nursing, Health Care Research Group on HIV/AIDS and Chronic Conditions. Fortaleza, Ceará, Brazil
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13
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Tsabedze N, Vachiat A, Zachariah D, Manga P. A New Face of Cardiac Emergencies: Human Immunodeficiency Virus-Related Cardiac Disease. Cardiol Clin 2018; 36:161-170. [PMID: 29173676 DOI: 10.1016/j.ccl.2017.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The human immunodeficiency virus epidemic is a major health challenge of the twenty-first century as the transition from infectious complications to noncommunicable disease becomes more evident. These patients may present to the emergency department with a variety of cardiovascular diseases, such as acute coronary syndromes, heart failure, pericardial disease, infective endocarditis, venothromboembolism, and other conditions. Increased awareness is needed among health care professionals to enhance adequate identification and promote prompt management of these patients.
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Affiliation(s)
- Nqoba Tsabedze
- Division of Cardiology, Department of Internal Medicine, Faculty of Health Sciences, University of Witwatersrand, 7 York Road, Parktown, Johannesburg 2000, South Africa
| | - Ahmed Vachiat
- Division of Cardiology, Department of Internal Medicine, Faculty of Health Sciences, University of Witwatersrand, 7 York Road, Parktown, Johannesburg 2000, South Africa
| | - Don Zachariah
- Division of Cardiology, Department of Internal Medicine, Faculty of Health Sciences, University of Witwatersrand, 7 York Road, Parktown, Johannesburg 2000, South Africa
| | - Pravin Manga
- Division of Cardiology, Department of Internal Medicine, Faculty of Health Sciences, University of Witwatersrand, 7 York Road, Parktown, Johannesburg 2000, South Africa.
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Abstract
PURPOSE OF REVIEW The purpose of this article is to review the literature on HIV and myocarditis and HIV-associated heart failure. RECENT FINDINGS Currently, 17 million people are receiving antiretroviral therapy (ART) globally. There is a decrease in mortality from HIV in the last decade with increased survival in those receiving ART. HIV-associated cardiac failure is on the increase, with more cases of diastolic dysfunction reported in the ART era. The pathophysiology of HIV-associated myocarditis is multifactorial. Cardiovascular magnetic resonance (CMR), through tissue characterization, demonstrates increased native T1 values which reflect both increased myocardial inflammation and fibrosis in HIV infection. SUMMARY HIV-associated myocarditis is common and may be an important cause of HIV-associated cardiac failure. CMR is an important imaging modality for the study of myocardial inflammation.
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15
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Gupta MK, Kaminski R, Mullen B, Gordon J, Burdo TH, Cheung JY, Feldman AM, Madesh M, Khalili K. HIV-1 Nef-induced cardiotoxicity through dysregulation of autophagy. Sci Rep 2017; 7:8572. [PMID: 28819214 PMCID: PMC5561171 DOI: 10.1038/s41598-017-08736-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 07/13/2017] [Indexed: 12/26/2022] Open
Abstract
Cardiovascular disease is a leading cause of co-morbidity in HIV-1 positive patients, even those in whom plasma virus levels are well-controlled. The pathogenic mechanism of HIV-1-associated cardiomyopathy is unknown, but has been presumed to be mediated indirectly, owing to the absence of productive HIV-1 replication in cardiomyocytes. We sought to investigate the effect of the HIV-1 auxiliary protein, Nef, which is suspected of extracellular release by infected CD4+ T cells on protein quality control and autophagy in cardiomyocytes. After detection of Nef in the serum of HIV-1 positive patients and the accumulation of this protein in human and primate heart tissue from HIV-1/SIV-infected cells we employed cell and molecular biology approaches to investigate the effect of Nef on cardiomyocyte-homeostasis by concentrating on protein quality control (PQC) pathway and autophagy. We found that HIV-1 Nef-mediated inhibition of autophagy flux leads to cytotoxicity and death of cardiomyocytes. Nef compromises autophagy at the maturation stage of autophagosomes by interacting with Beclin 1/Rab7 and dysregulating TFEB localization and cellular lysosome content. These effects were reversed by rapamycin treatment. Our results indicate that HIV-1 Nef-mediated inhibition of cellular PQC is one possible mechanism involved in the development of HIV-associated cardiomyopathy.
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Affiliation(s)
- Manish K Gupta
- Department of Neuroscience, Center for Neurovirology and Comprehensive NeuroAIDS Center, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Rafal Kaminski
- Department of Neuroscience, Center for Neurovirology and Comprehensive NeuroAIDS Center, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Brian Mullen
- Department of Neuroscience, Center for Neurovirology and Comprehensive NeuroAIDS Center, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Jennifer Gordon
- Department of Neuroscience, Center for Neurovirology and Comprehensive NeuroAIDS Center, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Tricia H Burdo
- Department of Neuroscience, Center for Neurovirology and Comprehensive NeuroAIDS Center, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Joseph Y Cheung
- Department of Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA.,Center for Translational Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Arthur M Feldman
- Department of Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA.,Cardiovascular Research Center, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Muniswamy Madesh
- Center for Translational Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA.,Department of Medical Genetics and Molecular Biochemistry, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Kamel Khalili
- Department of Neuroscience, Center for Neurovirology and Comprehensive NeuroAIDS Center, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA.
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16
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Leung C, Aris E, Mhalu A, Siril H, Christian B, Koda H, Samatta T, Maghimbi MT, Hirschhorn LR, Chalamilla G, Hawkins C. Preparedness of HIV care and treatment clinics for the management of concomitant non-communicable diseases: a cross-sectional survey. BMC Public Health 2016; 16:1002. [PMID: 27655406 PMCID: PMC5031255 DOI: 10.1186/s12889-016-3661-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 09/12/2016] [Indexed: 12/11/2022] Open
Abstract
Background In Sub-Saharan Africa, epidemiological studies have reported an increasing burden of non-communicable diseases (NCD) among people living with HIV. NCD management can be feasibly integrated into HIV care; however, clinic readiness to provide NCD services in these settings should first be assessed and gaps in care identified. Methods A cross-sectional survey conducted in July 2013 assessed the resources available for NCD care at 14 HIV clinics in Dar es Salaam, Tanzania. Survey items related to staff training, protocols, and resources for cardiovascular disease risk factor screening, management, and patient education. Results 43 % of clinics reported treating patients with hypertension; however, only 21 % had a protocol for NCD management. ECHO International Health standards for essential clinical equipment were used to measure clinic readiness; 36 % met the standard for blood pressure cuffs, 14 % for glucometers. Available laboratory tests for NCD included blood glucose (88 %), urine dipsticks (78 %), and lipid panel (57 %). 21 % had a healthcare worker with NCD training. All facilities provided some form of patient education, but only 14 % included diabetes, 57 % tobacco cessation, and 64 % weight management. Conclusions A number of gaps were identified in this sample of HIV clinics that currently limit the ability of Tanzanian healthcare workers to diagnose and manage NCD in the context of HIV care. Integrated NCD and HIV care may be successfully achieved in these settings with basic measures incorporated into existing infrastructures at minimal added expense, i.e., improving access to basic functioning equipment, introducing standardized treatment guidelines, and improving healthcare worker education.
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Affiliation(s)
- Claudia Leung
- Feinberg School of Medicine, Northwestern University, 420 E Superior Street, Chicago, IL, 60611, USA.
| | - Eric Aris
- Management and Development for Health HIV/AIDS Care and Treatment Program, P.O. Box 79810. Plot #802, Mwai Kibaki Road, Mikocheni, Dar es Salaam, Tanzania
| | - Aisa Mhalu
- Management and Development for Health HIV/AIDS Care and Treatment Program, P.O. Box 79810. Plot #802, Mwai Kibaki Road, Mikocheni, Dar es Salaam, Tanzania
| | - Hellen Siril
- Management and Development for Health HIV/AIDS Care and Treatment Program, P.O. Box 79810. Plot #802, Mwai Kibaki Road, Mikocheni, Dar es Salaam, Tanzania
| | - Beatrice Christian
- Management and Development for Health HIV/AIDS Care and Treatment Program, P.O. Box 79810. Plot #802, Mwai Kibaki Road, Mikocheni, Dar es Salaam, Tanzania
| | - Happiness Koda
- Management and Development for Health HIV/AIDS Care and Treatment Program, P.O. Box 79810. Plot #802, Mwai Kibaki Road, Mikocheni, Dar es Salaam, Tanzania
| | - Talumba Samatta
- Management and Development for Health HIV/AIDS Care and Treatment Program, P.O. Box 79810. Plot #802, Mwai Kibaki Road, Mikocheni, Dar es Salaam, Tanzania
| | - Martha Tsere Maghimbi
- Management and Development for Health HIV/AIDS Care and Treatment Program, P.O. Box 79810. Plot #802, Mwai Kibaki Road, Mikocheni, Dar es Salaam, Tanzania
| | - Lisa R Hirschhorn
- Department of Global Health and Social Medicine, Harvard Medical School, 401 Park Drive 3East, Boston, MA, 02215, USA
| | - Guerino Chalamilla
- Management and Development for Health HIV/AIDS Care and Treatment Program, P.O. Box 79810. Plot #802, Mwai Kibaki Road, Mikocheni, Dar es Salaam, Tanzania
| | - Claudia Hawkins
- Feinberg School of Medicine, Northwestern University, 420 E Superior Street, Chicago, IL, 60611, USA
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17
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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.
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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
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18
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Msoka TF, Van Guilder GP, Smulders YM, van Furth M, Bartlett JA, van Agtmael MA. Antiretroviral treatment and time since HIV-1 diagnosis are associated with large artery stiffness in sub-Saharan African HIV-1 patients. Artery Res 2016. [DOI: 10.1016/j.artres.2016.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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19
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Lambert CT, Sandesara PB, Hirsh B, Shaw LJ, Lewis W, Quyyumi AA, Schinazi RF, Post WS, Sperling L. HIV, highly active antiretroviral therapy and the heart: a cellular to epidemiological review. HIV Med 2015; 17:411-24. [PMID: 26611380 DOI: 10.1111/hiv.12346] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2015] [Indexed: 12/18/2022]
Abstract
The advent of potent highly active antiretroviral therapy (HAART) for persons infected with HIV-1 has led to a "new" chronic disease with complications including cardiovascular disease (CVD). CVD is a significant cause of morbidity and mortality in persons with HIV infection. In addition to traditional risk factors such as smoking, hypertension, insulin resistance and dyslipidaemia, infection with HIV is an independent risk factor for CVD. This review summarizes: (1) the vascular and nonvascular cardiac manifestations of HIV infection; (2) cardiometabolic effects of HAART; (3) atherosclerotic cardiovascular disease (ASCVD) risk assessment, prevention and treatment in persons with HIV-1 infection.
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Affiliation(s)
- C T Lambert
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - P B Sandesara
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - B Hirsh
- Division of Cardiology, Department of Medicine, Mt Sinai School of Medicine, New York, NY, USA
| | - L J Shaw
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - W Lewis
- Department of Pathology, Emory University School of Medicine, Atlanta, GA, USA
| | - A A Quyyumi
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - R F Schinazi
- Department of Pediatrics, Center for AIDS Research, Emory University School of Medicine, Atlanta, GA, USA
| | - W S Post
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - L Sperling
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
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20
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ACCF 2012 expert consensus document on practical clinical considerations in the interpretation of troponin elevations: a report of the American College of Cardiology Foundation task force on Clinical Expert Consensus Documents. J Am Coll Cardiol 2012; 60:2427-63. [PMID: 23154053 DOI: 10.1016/j.jacc.2012.08.969] [Citation(s) in RCA: 263] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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21
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Merchant RH, Lala MM. Common clinical problems in children living with HIV/AIDS: systemic approach. Indian J Pediatr 2012; 79:1506-13. [PMID: 23015361 DOI: 10.1007/s12098-012-0865-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Accepted: 08/03/2012] [Indexed: 11/26/2022]
Abstract
Clinical manifestations in children living with HIV/ AIDS differ from those in adults due to poorly developed immunity that allows greater dissemination throughout various organs. In developing countries, HIV-infected children have an increased frequency of malnutrition and common childhood infections such as ear infections, pneumonias, gastroenteritis and tuberculosis. The symptoms common to many treatable conditions, such as recurrent fever, diarrhea and generalized dermatitis, tend to be more persistent and severe and often do not respond as well to treatment. The use of Anti Retroviral Therapy (ART) has greatly increased the long term survival of perinatally infected children so that AIDS is becoming a manageable chronic illness. As the immunity is maintained, the incidence of infectious complications is declining while noninfectious complications of HIV are more frequently encountered. Regular clinical monitoring with immunological and virological monitoring and the introduction of genotypic and phenotypic resistance testing where resources are available have allowed for dramatically better clinical outcomes. However, these growing children are left facing the challenges of lifelong adherence with complex treatment regimens, compounded by complex psycho-social, mental and neuro-cognitive issues. These unique challenges must be recognized and understood in order to provide appropriate medical management.
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Affiliation(s)
- Rashid H Merchant
- Department of Pediatrics, Dr. Balabhai Nanavati Hospital, S. V. Road, Vile Parle (West), Mumbai 400056, India.
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22
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Conte AH, Esmailian F, LaBounty T, Lubin L, Hardy WD, Yumul R. The patient with the human immunodeficiency virus-1 in the cardiovascular operative setting. J Cardiothorac Vasc Anesth 2012; 27:135-55. [PMID: 22920840 DOI: 10.1053/j.jvca.2012.06.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Indexed: 01/01/2023]
Affiliation(s)
- Antonio Hernandez Conte
- Division of Cardiothoracic Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
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23
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Olusegun-Joseph DA, Ajuluchukwu JNA, Okany CC, Mbakwem AC, Oke DA, Okubadejo NU. Echocardiographic patterns in treatment-naïve HIV-positive patients in Lagos, south-west Nigeria. Cardiovasc J Afr 2012; 23:e1-6. [PMID: 22907266 PMCID: PMC3734877 DOI: 10.5830/cvja-2012-048] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2011] [Accepted: 06/05/2012] [Indexed: 11/25/2022] Open
Abstract
Introduction Cardiovascular abnormalities are common in HIV-infected patients, although often clinically quiescent. This study sought to identify by echocardiography early abnormalities in treatment-naïve patients. Methods One hundred patients and 50 controls with no known traditional risk factors for cardiovascular disease were recruited for the study. The cases and controls were matched for age, gender and body mass index. Both groups had clinical and echocardiographic evaluation for cardiac abnormalities, and CD4 count was measured in all patients. Results The cases comprised 57 females (57.0%) and 43 males (43.0%), while the controls were 28 females (56.0%) and 22 males (44.0%) (χ2 = 0.01; p = 0.913). The mean age of the cases was 33.2 ± 7.7, while that of the controls was 31.7 ± 9.7 (t = 1.02; p = 0.31). Echocardiographic abnormalities were significantly more common in the cases than the controls (78 vs 16%; p = 0.000), including systolic dysfunction (30 vs 8%; p = 0.024) and diastolic dysfunction (32 vs 8%; p = 0.002). Other abnormalities noted in the cases were pericardial effusion in 47% (χ2 = 32.10; p = 0.000) and dilated cardiomyopathy in 5% (five); none of the controls had either complication. One patient each had aortic root dilatation, mitral valve prolapse and isolated right heart dilatation and dysfunction. Conclusion Cardiac abnormalities are more common in HIV-infected people than in normal controls. A careful initial and periodic cardiac evaluation to detect early involvement of the heart in the HIV disease is recommended.
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Affiliation(s)
- D A Olusegun-Joseph
- Department of Cardiology, Lagos University Teaching Hospital, Lagos, Nigeria.
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Fares S, Irfan FB. Thoracic Emergencies in Immunocompromised Patients. Emerg Med Clin North Am 2012; 30:565-89, x. [DOI: 10.1016/j.emc.2011.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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25
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Patel N, Patel N, Khan T, Patel N, Espinoza LR. HIV Infection and Clinical Spectrum of Associated Vasculitides. Curr Rheumatol Rep 2011; 13:506-12. [DOI: 10.1007/s11926-011-0214-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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26
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HIV infection and cocaine use induce endothelial damage and dysfunction in African Americans. Int J Cardiol 2011; 161:83-7. [PMID: 21600668 DOI: 10.1016/j.ijcard.2011.04.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2011] [Revised: 03/25/2011] [Accepted: 04/25/2011] [Indexed: 11/23/2022]
Abstract
BACKGROUND Clinical and epidemiological evidence suggests that HIV infection and cocaine use are associated with an increased risk of premature atherosclerosis. The underlying mechanisms linking HIV infection and cocaine use with early atherosclerosis remain elusive. METHODS AND RESULTS Endothelin-1 (ET-1) levels in 360 African American participants in Baltimore, Maryland were measured. Quantile regression analysis was performed to examine the associations between ET-1, HIV infection, cocaine use, and other relevant clinical factors. The median of ET-1 in plasma, (1.05 pg/mL with interquartile range: 0.73, 1.40) for those with HIV infection was significantly higher than values for those without HIV infection (0.74 pg/mL with interquartile range: 0.61, 0.93). The median of ET-1 was markedly higher in chronic cocaine users (0.96 pg/mL with interquartile range: 0.71, 1.36) than that in non-cocaine users (0.72 pg/mL with interquartile range: 0.58, 1.06). Multivariate quantile regression suggested that HIV infection and duration of cocaine use were independently associated with plasma ET-1 levels after controlling for potential confounding factors. CONCLUSIONS This study may provide insight into the mechanism of premature atherosclerosis in HIV-infected cocaine users and suggest that measurement of ET-1 in plasma can be used as a marker of early atherosclerosis in HIV infected patients and cocaine users.
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Dhillon NK, Li F, Xue B, Tawfik O, Morgello S, Buch S, Ladner AO. Effect of cocaine on human immunodeficiency virus-mediated pulmonary endothelial and smooth muscle dysfunction. Am J Respir Cell Mol Biol 2010; 45:40-52. [PMID: 20802087 DOI: 10.1165/rcmb.2010-0097oc] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Human immunodeficiency virus (HIV)-associated pulmonary arterial hypertension (PAH) is a devastating, noninfectious complication of acquired immune deficiency syndrome, and the majority of HIV-PAH cases occur in individuals with a history of intravenous drug use (IVDU). However, although HIV-1 and IVDU have been associated with PAH independently or in combination, the pathogenesis of the disproportionate presence of HIV-PAH in association with IVDU has yet to be characterized. The objective of this study was to obtain a better understanding of the interactions between HIV-1 and cocaine to help uncover the mechanism(s) of the development of HIV-PAH. We observed that exposure of HIV-infected macrophages or HIV-Trans-Activator of Transcription (Tat)-treated pulmonary endothelial cells to cocaine enhanced the expression of platelet-derived growth factor (PDGF)-BB. Simultaneous treatment with Tat and cocaine, on the other hand, exacerbated both the disruption of tight junction proteins (TJPs), with enhanced permeability in pulmonary endothelial cells, and the proliferation of pulmonary smooth muscle cells (pSMCs) compared with either treatment alone. Histological examination of HIV plus IVDU human lung sections showed signs of early pulmonary arteriopathy, severe down-modulation of TJPs, and increased expression of PDGF-BB compared with the lung sections from individuals who are infected with HIV and without history of IVDU. Interestingly, blocking of PDGF receptor signaling with the receptor antagonist or small interfering RNA has been shown to inhibit the increase in proliferation of pSMCs on Tat and cocaine exposure. Our results, therefore, support an additive effect of cocaine to HIV infection in the development of pulmonary arteriopathy through enhancement of endothelial dysfunction and proliferation of pSMCs, while also suggesting PDGF-PDGF receptor axis as a potential target for use in clinical intervention.
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Affiliation(s)
- Navneet K Dhillon
- Department of Molecular and Integrative Physiology, 3008 Hixon, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA.
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Cardiac Isoform of Alpha 2 Macroglobulin and Its Reliability as a Cardiac Marker in HIV Patients. Heart Lung Circ 2010; 19:93-5. [DOI: 10.1016/j.hlc.2009.10.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2009] [Revised: 10/19/2009] [Accepted: 10/19/2009] [Indexed: 11/23/2022]
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29
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Sani MU. Myocardial disease in human immunodeficiency virus (HIV) infection: a review. Wien Klin Wochenschr 2008; 120:77-87. [PMID: 18322768 DOI: 10.1007/s00508-008-0935-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2007] [Accepted: 12/28/2007] [Indexed: 10/22/2022]
Abstract
Heart muscle disease is the most important cardiovascular manifestation of HIV infection and is likely to become even more prevalent as HIV infected patients live longer. This may present as myocarditis, dilated cardiomyopathy or isolated left or right ventricular dysfunction. Myocardial involvement in HIV infection is multifactorial and may arise as a result of myocardial invasion with HIV itself, opportunistic infections, viral infections, autoimmune response to viral infection, drug-related cardiac toxicity, nutritional deficiencies, and prolonged immunosuppression. Both adults and children are affected with severity ranging from incidental microscopic inflammatory findings at autopsy to clinically significant cardiac disease with chronic cardiac dysfunction. It is associated with a poor prognosis, and results in symptomatic heart failure in up to 5% of HIV patients. Clinical pathological studies from the pre-HAART era show a 30% prevalence of cardiomyopathy in patients with AIDS. The introduction of highly active antiretroviral therapy (HAART) regimens has substantially modified the course of HIV disease by lengthening survival and improving quality of life of HIV-infected patients. There is also good evidence that HAART significantly reduces the incidence of cardiovascular manifestations of HIV infection. By preventing opportunistic infections and reducing the incidence of myocarditis, HAART regimens have reduced the prevalence of HIV-associated cardiomyopathy by almost 7-fold from the pre-HAART era. HAART is however only available to a minority of HIV infected individuals in most areas of the world and studies from the pre-HAART period still apply. In this review, the aetiopathogenesis and presentation of HIV related myocardial disease were reviewed and measures taken to improve survival discussed.
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Oberdorfer P, Sittiwangkul R, Puthanakit T, Pongprot Y, Sirisanthana V. Dilated cardiomyopathy in three HIV-infected children after initiation of antiretroviral therapy. Pediatr Int 2008; 50:251-4. [PMID: 18353072 DOI: 10.1111/j.1442-200x.2008.02537.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Peninnah Oberdorfer
- Division of Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Chiang Mai University Chiang Mai, Thailand.
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Study comparing lipid metabolism disorders and effectiveness of treatment in HIV infected patients on long-term treatment with various thymidine analogues. HIV & AIDS REVIEW 2008. [DOI: 10.1016/s1730-1270(10)60005-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Affiliation(s)
- Samuel C Hughes
- Department of Anesthesia and Perioperative Care, San Francisco General Hospital, San Francisco, California 94110, USA.
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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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Ramasamy S, Omnath R, Rathinavel A, Kannan P, Dhandapany PS, Annapoorani P, Balakumar P, Singh M, Ganesh R, Selvam GS. Cardiac isoform of alpha 2 macroglobulin, an early diagnostic marker for cardiac manifestations in AIDS patients. AIDS 2006; 20:1979-81. [PMID: 16988522 DOI: 10.1097/01.aids.0000247122.97079.71] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study investigated the possible role of the cardiac isoform of alpha 2-macroglobulin (CA2M) as an early diagnostic marker for HIV-associated cardiovascular manifestations. A total of 349 samples were analysed by Western blot and quantified by sandwich enzyme-linked immunosorbent assay. The levels of CA2M present in sera of HIV-associated cardiac diseases were significantly higher than those of HIV without cardiac involvement and healthy sera. CA2M may act as a novel diagnostic marker to identify cardiac manifestations in HIV/AIDS patients.
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Affiliation(s)
- Subbiah Ramasamy
- Department of Biochemistry, School of Biological Sciences, Madurai Kamaraj University, Madurai, Tamilnadu, India
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Abstract
Human immunodeficiency virus [HIV disease or acquired immunodeficiency syndrome (AIDS)] is the greatest health crisis of the twentieth and early twenty-first century. In sub-Saharan Africa, the epidemic rivals the "Black Death" of fourteenth-century Europe. AIDS is a multiorgan disease that has broad implications for anesthesiologists. New drug therapies are highly effective in most cases and have significant potential for drug interactions. The purpose of this article is to help anesthesiologists better manage persons who have HIV/AIDS in the operating room, labor and delivery suite, and other areas in which this patient population will require an increasing amount of care.
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Affiliation(s)
- Samuel C Hughes
- Department of Anesthesia and Perioperative Care, University of California-San Francisco, San Francisco, CA, USA.
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Trachiotis GD, Alexander EP, Benator D, Gharagozloo F. Cardiac surgery in patients infected with the human immunodeficiency virus. Ann Thorac Surg 2003; 76:1114-8; discussion 1118. [PMID: 14529996 DOI: 10.1016/s0003-4975(02)04756-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Highly active antiretroviral therapy has dramatically impacted the natural history of human immunodeficiency virus (HIV) infection and may be associated with lipodystrophy and accelerated coronary artery disease. Patients with HIV are consequently increasingly likely to present for cardiac surgery. METHODS A retrospective review of 37 consecutive patients at two integrated centers from 1994 to 2000 was conducted. Standard database and follow-up information was supplemented with data on opportunistic infections, CD4 count, viral load, New York Heart Association status, and angina status. Risk to operating room personnel was also reviewed. RESULTS Median age was 41 years; 34 of 37 patients were male. Operations performed were coronary artery bypass graft ([CABG] 27), aortic valve replacement ([AVR] 4), AVR/CABG (2), AVR/mitral valve repair (1), mitral valve repair (1), excision of atrial masses (1), and tricuspid valve repair (1). Complications included death in 1 of 37 (2.7%), sepsis in 2 of 37 (5.4%), deep sternal infection in 1 of 37 (2.7%), bleeding in 2 of 37 (5.4%), prolonged ventilation in 2 of 37 (5.4%), and readmission in 8 of 37 (21.6%). Actuarial freedom from a composite end point of angina, death, myocardial infarction, repeat revascularization, and congestive heart failure was 81% at 3 years with no late deaths. Preoperative and follow-up CD4 counts and viral loads were not significantly different at a mean follow-up of 28 months. No patients progressed from HIV positive status to AIDS during the study period. Six "needle stick" injuries requiring antiretroviral prophylaxis occurred in 5 caregivers without seroconversion. CONCLUSIONS In selected patients infected with HIV, risks and outcomes of cardiac surgery are acceptable. With concomitant highly active antiretroviral therapy, intermediate HIV and cardiac status appear to be favorable. Needle stick injuries occur at a rate mandating optimal reduction of patient viral loads preoperatively.
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Affiliation(s)
- Gregory D Trachiotis
- Division of Cardiothoracic Surgery, VAMC, and George Washington University Medical Center, Washington, DC 20037, USA
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Abstract
Many infections have been found to be associated with antiphospholipid antibodies (aPL), although a pathogenic role for these antibodies has not usually been obvious except in a few isolated cases. Two types of aPL have been referred to as "autoimmune" and "infectious" types. This distinction, however, has subsequently been found not to be absolute.
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Affiliation(s)
- R A Asherson
- Rheumatic Diseases Unit, Department of Medicine, University of Cape Town School of Medicine and Groote Schuur Hospital, Cape Town, South Africa
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Clinical and biological insights in HIV-associated cardiovascular disease in the era of highly active antiretroviral therapy. AIDS 2003. [DOI: 10.1097/00002030-200304001-00001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
As longevity increases in HIV-infected individuals after the introduction of highly active antiretroviral therapy regimens, long-term effects such as cardiovascular disease and, more specifically, symptomatic heart failure are emerging as leading health issues. In the present review article, we discuss HIV-associated cardiovascular disease, focusing on etiopathogenetic mechanisms that may play a role in diagnosis, management, and therapy of HIV-associated heart failure in the highly active antiretroviral therapy era.
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Affiliation(s)
- Giuseppe Barbaro
- Department of Medical Pathophysiology, University La Sapienza, Rome, Italy.
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Nzuobontane D, Blackett KN, Kuaban C. Cardiac involvement in HIV infected people in Yaounde, Cameroon. Postgrad Med J 2002; 78:678-81. [PMID: 12496326 PMCID: PMC1742549 DOI: 10.1136/pmj.78.925.678] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To study the cardiac abnormalities in HIV infected patients in relation to the clinical stage of the disease and the immunological status of the patients. METHODS A total 75 consecutive patients tested for HIV on the basis of clinical suspicion of the disease from July to September 1996 at the University Hospital Centre, Yaounde, Cameroon were recruited. The patients were classified into AIDS, HIV positive non-AIDS, and HIV negative according to clinical findings and outcome of ELISA and western blot testing. Every patient underwent a clinical examination, two dimensional and M-mode echocardiography, and blood lymphocyte typing. RESULTS Dilated cardiomyopathy occurred in 7/30 (23.33%) AIDS patients, 1/24 (4.17%) HIV positive non-AIDS patient, but in none of the HIV negative patients. Other echocardiographic abnormalities included pericardial separation, effusion, thickening, and mitral valve prolapse. Although these abnormalities were more frequent in HIV infected patients, the differences did not reach levels of statistical significance. Dilated cardiomyopathy occurred in six (31.58%) of the patients with a CD4 cell count < or =100/mm(3) and two (6.06%) in those with absolute CD4 counts >100/mm(3) (chi(2) = 4.02, p = 0.03). CONCLUSIONS Cardiovascular abnormalities are frequent in African HIV infected patients but clinically discrete. Low CD4 cell counts are associated with dilated cardiomyopathy. These abnormalities should be expected with greater frequency in cardiological clinical practice as management of opportunistic infections improves in a situation of continued high disease prevalence in Africa.
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Affiliation(s)
- D Nzuobontane
- Wirral Hospital Trust, St Catherine's Hospital, Birkenhead, Merseyside, UK.
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Meng Q, Lima JAC, Lai H, Vlahov D, Celentano DD, Strathdee S, Nelson KE, Tong W, Lai S. Use of HIV protease inhibitors is associated with left ventricular morphologic changes and diastolic dysfunction. J Acquir Immune Defic Syndr 2002; 30:306-10. [PMID: 12131567 DOI: 10.1097/00126334-200207010-00006] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
HIV protease inhibitor (PI) therapy may be associated with cardiac and vascular complications. We assessed the effects of PIs on cardiac function and structure. M-mode, cross-sectional, and Doppler echocardiography were performed in 98 consecutive black adults aged 25 to 45 years with HIV infection who were receiving antiretroviral therapy. Forty-five (56.1%) took PIs (mean duration of PI use: 29.6 +/- 12.2 months). No significant differences between the PI and non-PI groups were found in left ventricular (LV) systolic function and cardiac valve regurgitation. Those who took PIs had a significantly higher interventricular septum thickness (1.1 +/- 0.3 vs. 1.0 +/- 0.2 cm; p =.049), LV posterior wall thickness (1.1 +/- 0.2 vs. 1.0 +/- 0.2; p =.027), and lower ratio of early peak velocity (E wave) to late peak velocity (A wave) (E/A ratio) (1.36 +/- 0.30 vs. 1.53 +/- 0.31; p =.023) than did those who did not take PIs. Linear regression analyses indicated that posterior wall thickness, septum thickness, left atrial dimension, LV mass, and E/A ratios were significantly associated with the log-transformed duration of PI therapy. Despite the proven benefits of PIs in patients with HIV infection, this report demonstrates an association between continued PI intake and LV hypertrophy that should be known and taken into consideration in the analysis of cardiac structure and function in patients with HIV infection.
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Affiliation(s)
- Qingyi Meng
- Department of Internal Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland 21205, USA
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Barbaro G. HIV-Associated Cardiomyopathy is not Keshan Disease. Med Chir Trans 2002; 95:324. [PMID: 12042392 PMCID: PMC1279931 DOI: 10.1177/014107680209500627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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