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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: 0] [Impact Index Per Article: 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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Assessment of Clinical Features in HIV-Infected Patients with Acute Coronary Syndromes Undergoing Percutaneous Coronary Intervention in China. J Interv Cardiol 2022; 2022:8351304. [PMID: 35847237 PMCID: PMC9256447 DOI: 10.1155/2022/8351304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 06/01/2022] [Accepted: 06/15/2022] [Indexed: 11/24/2022] Open
Abstract
Objectives We aimed to compare coronary risk factors, burden of coronary artery disease (CAD), and 1-year prognosis of people living with HIV (PLWH) and HIV-negative controls who underwent percutaneous coronary intervention (PCI) for acute coronary syndromes (ACSs). Background Cardiovascular disease is drawing more and more attention in PLWH since effective antiretroviral therapy (ART) has been available. Clinical characteristics and outcomes of PLWH undergoing PCI for ACS in China remain unknown. Methods We compared demographic characteristics, angiographic features, and 1-year outcomes of 48 PLWH versus 48 HIV-negative controls matched for age (±2 years), sex, diabetes mellitus, and year of PCI (±2 years) in Beijing Ditan Hospital, Capital Medical University from January 2008 to November 2020. Results In PLWH (mean age: 53.6 ± 10.6 years, 95.8% male, and 79.2% on ART), high-density lipoprotein cholesterol was lower than in HIV-negative controls; however, the statin use was more common, the incidence of hypertension was lower, and low-density lipoprotein cholesterol, and the body mass index were significantly lower than in controls. Two groups had a similar extent of coronary atherosclerosis as measured by the presence of multivessel diseases and the median Gensini score; however, lesions of PLWH were longer and were more likely to locate at the proximal segment of the coronary artery. In addition, the risk of major adverse cardiac and cerebrovascular events at 1 year was similar in both groups. Conclusion PLWH undergoing PCI displayed similar CAD burden and 1-year prognosis compared with HIV-negative patients. Early detection of cardiovascular risk factors and appropriate secondary prevention of CAD in PLWH might alleviate the risk of severe adverse cardiovascular events.
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Parks MM, Secemsky EA, Yeh RW, Shen C, Choi E, Kazi DS, Hsue PY. Longitudinal management and outcomes of acute coronary syndrome in persons living with HIV infection. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2021; 7:273-279. [PMID: 33226071 DOI: 10.1093/ehjqcco/qcaa088] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 11/02/2020] [Accepted: 11/12/2020] [Indexed: 11/14/2022]
Abstract
AIMS Persons living with HIV (PLWH) have increased cardiovascular mortality, which may in part be due to differences in the management of acute coronary syndromes (ACS). The purpose of this study was to compare the in-hospital and post-discharge management and outcomes of ACS among persons with and without HIV. METHODS AND RESULTS This was a retrospective cohort study using data from Symphony Health, a data warehouse. All patients admitted between 1 January 2014 and 31 December 2016 with ACS were identified by International Classification of Diseases billing codes. Multivariate logistic regression models were used to examine in-hospital, 30-day and 12-month event rates between groups. A total of 1 125 126 individuals were included, 6612 (0.59%) with HIV. Persons living with HIV were younger (57.4 ± 10.5 vs. 67.4 ± 12.9 years, P< 0.0001) and had more medical comorbidities. Acute coronary syndrome type did not differ significantly with HIV status. Persons living with HIV were less likely to undergo coronary angiography (35.2% vs. 37.2%, adjusted OR 0.87, 95% CI 0.83-0.92, P < 0.0001), and those with both HIV and STEMI underwent fewer drug-eluting stents (60.1% vs. 68.5%, adjusted OR 0.81, 95% CI 0.68-0.96, P = 0.016). Persons living with HIV had higher adjusted rates of inpatient mortality (OR 1.29, 95% CI 1.15-1.44; P < 0.0001), 30-day readmission (OR 1.18, 95% CI 1.09-1.27; P < 0.0001) and 12-month mortality (OR 1.32, 95% CI 1.22-1.44; P < 0.0001). Twelve months following discharge, PLWH filled cardiac medications at lower rates. CONCLUSION In a contemporary cohort of persons hospitalized for ACS, PLWH received less guideline-supported interventional and medical therapies and had worse clinical outcomes. Strategies to optimize care are warranted in this unique population.
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Affiliation(s)
- Monica M Parks
- Department of Medicine, University of Colorado Anschutz Medical Campus, 12631 East 17th Avenue, Mail Stop B130, Aurora, CO 80045, USA
| | - Eric A Secemsky
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Robert W Yeh
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Changyu Shen
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Eunhee Choi
- Department of Medicine, University of Colorado Anschutz Medical Campus, 12631 East 17th Avenue, Mail Stop B130, Aurora, CO 80045, USA
| | - Dhruv S Kazi
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Priscilla Y Hsue
- Department of Medicine, University of California San Francisco, USA
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McCutcheon K, Triantafyllis AS, Van den Eynde J, Oosterlinck W, Vachiat A, Tsabedze N, Zachariah D, Manga P, Bennett J. Coronary revascularization in patients with HIV. Trends Cardiovasc Med 2021; 32:163-169. [PMID: 33626383 DOI: 10.1016/j.tcm.2021.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/15/2021] [Accepted: 02/18/2021] [Indexed: 12/14/2022]
Abstract
With combined antiretroviral therapy, people living with HIV (PLWH) survive longer and are now more likely to die from cardiovascular diseases. PLWH presenting with a ST-segment elevation myocardial infarction are likely to have a high thrombus burden and are at high risk for in-hospital and long-term adverse events. An increasing number of PLWH are presenting with stable coronary artery disease related to atherosclerosis. Revascularization in these patients is associated with higher in-hospital and long-term major adverse cardiovascular events, including stent thrombosis and in-stent restenosis. However, data in this expanding population concerning optimal revascularization strategy are still lacking. In particular, data comparing percutaneous versus surgical revascularization in PLWH are needed. In this review we highlight the currently available data related to coronary revascularization in PLWH.
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Affiliation(s)
- Keir McCutcheon
- Department of Cardiovascular Medicine, University Hospitals Leuven, Belgium; Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium.
| | | | - Jef Van den Eynde
- Department of Cardiovascular Diseases, Research Unit of Cardiac Surgery, University Hospitals Leuven
| | - Wouter Oosterlinck
- Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Cardiovascular Diseases, Research Unit of Cardiac Surgery, University Hospitals Leuven
| | - Ahmed Vachiat
- Wits Donald Gordon Medical Centre, Johannesburg, South Africa
| | - Nqoba Tsabedze
- Division of Cardiology, Department of Internal Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Pravin Manga
- Wits Donald Gordon Medical Centre, Johannesburg, South Africa; Division of Cardiology, Department of Internal Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Johan Bennett
- Department of Cardiovascular Medicine, University Hospitals Leuven, Belgium; Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
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Bernelli C, Danzi GB, Cerrato E, Pierini S, Ornaghi MG, Botta L, Gentile F, Migliorino GM, Squillace N. Cardiovascular Events Recurrence and Coronary Artery Disease in HIV Patients: The Price We Have to Pay for the Chronicization of the Disease. Can J Cardiol 2019; 36:127-134. [PMID: 31813674 DOI: 10.1016/j.cjca.2019.07.636] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 07/26/2019] [Accepted: 07/26/2019] [Indexed: 10/26/2022] Open
Abstract
The introduction of combination of antiretroviral therapy and advancement in care of HIV have dramatically changed the natural history of patients living with HIV. Today, HIV+ patients have a life expectancy not significantly different from HIV uninfected people. However, concerns remain about all the comorbidities associated with aging and the effects of chronic therapies in such high-risk patients. HIV+ subjects exhibited accelerated atherosclerosis and have a 1.5- to 2-fold increased risk of having coronary artery disease (CAD), usually presenting early and aggressively with acute coronary events. Furthermore, HIV+ patients with CAD often complain recurrent acute coronary events, and they are plagued by major adverse cardiac outcomes. This review will focus on the current understanding of the CAD phenotype in HIV+ patients highlighting the topic of acute coronary event recurrence and underscoring the role of percutaneous management strategies in the light of information derived from invasive coronary imaging.
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Affiliation(s)
- Chiara Bernelli
- Interventional Cardiology Unit, Ospedale Santa Corona, Pietra Ligure, Italy.
| | | | - Enrico Cerrato
- Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano and Rivoli degli Infermi Hospital, Rivoli, Turin, Italy
| | - Simona Pierini
- Interventional Cardiology Unit ASST Nord-Milano, Ospedale Bassini, Via Massimo Gorki, Milano, Italy
| | | | - Luca Botta
- Cardiac surgery Unit, ASST Grande Ospedale Metropolitano Niguarda, Piazza dell'Ospedale Maggiore, Milano, Italy
| | - Francesco Gentile
- Interventional Cardiology Unit ASST Nord-Milano, Ospedale Bassini, Via Massimo Gorki, Milano, Italy
| | - Guglielmo Marco Migliorino
- Infectious Diseases Unit, Azienda Socio-Sanitaria Territoriale di MONZA, San Gerardo Hospital-University of Milano-Bicocca, Monza, Italy
| | - Nicola Squillace
- Infectious Diseases Unit, Azienda Socio-Sanitaria Territoriale di MONZA, San Gerardo Hospital-University of Milano-Bicocca, Monza, Italy
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Feinstein MJ, Hsue PY, Benjamin LA, Bloomfield GS, Currier JS, Freiberg MS, Grinspoon SK, Levin J, Longenecker CT, Post WS. Characteristics, Prevention, and Management of Cardiovascular Disease in People Living With HIV: A Scientific Statement From the American Heart Association. Circulation 2019; 140:e98-e124. [PMID: 31154814 DOI: 10.1161/cir.0000000000000695] [Citation(s) in RCA: 368] [Impact Index Per Article: 73.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
As early and effective antiretroviral therapy has become more widespread, HIV has transitioned from a progressive, fatal disease to a chronic, manageable disease marked by elevated risk of chronic comorbid diseases, including cardiovascular diseases (CVDs). Rates of myocardial infarction, heart failure, stroke, and other CVD manifestations, including pulmonary hypertension and sudden cardiac death, are significantly higher for people living with HIV than for uninfected control subjects, even in the setting of HIV viral suppression with effective antiretroviral therapy. These elevated risks generally persist after demographic and clinical risk factors are accounted for and may be partly attributed to chronic inflammation and immune dysregulation. Data on long-term CVD outcomes in HIV are limited by the relatively recent epidemiological transition of HIV to a chronic disease. Therefore, our understanding of CVD pathogenesis, prevention, and treatment in HIV relies on large observational studies, randomized controlled trials of HIV therapies that are underpowered to detect CVD end points, and small interventional studies examining surrogate CVD end points. The purpose of this document is to provide a thorough review of the existing evidence on HIV-associated CVD, in particular atherosclerotic CVD (including myocardial infarction and stroke) and heart failure, as well as pragmatic recommendations on how to approach CVD prevention and treatment in HIV in the absence of large-scale randomized controlled trial data. This statement is intended for clinicians caring for people with HIV, individuals living with HIV, and clinical and translational researchers interested in HIV-associated CVD.
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Peyracchia M, Verardi R, Rubin SR, Abu-Assi E, Montrucchio C, Perl L, Grossomarra W, Calcagno A, Omedè P, Montefusco A, Bonora S, Moretti C, D'Amico M, Mauro R, D'Ascenzo F. In-hospital and long-term outcomes of HIV-positive patients undergoing PCI according to kind of stent: a meta-analysis. J Cardiovasc Med (Hagerstown) 2019; 20:321-326. [PMID: 30664538 DOI: 10.2459/jcm.0000000000000767] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Pathogenesis of cardiovascular disease in HIV-positive patients is related to the interaction between traditional and HIV-specific factors. Limited data are available regarding the prognosis of HIV-positive patients undergoing percutaneous coronary intervention (PCI). METHODS All observational studies evaluating the prognosis of HIV-positive patients treated with PCI were included. In-hospital and long-term major adverse cardiac events (MACE) [composite endpoint of all-cause death or myocardial infarction (MI)] were the primary endpoints, whereas in-hospital and long-term all-cause death, cardiovascular death, MI, stent thrombosis, target vessel revascularization (TVR), target lesion revascularization (TLR), and bleeding complications were the secondary ones. FINDINGS In all, 1243 patients in nine studies were included, with a mean age of 54 years. Among them, 12% were female and 91% were admitted for acute coronary syndromes. In-hospital MACE occurred in 6.0% (5.4-6.6), death in 4.2% (2.6-5.9), and MI in 1.3% (0-2.8), whereas major bleeding occurred in 2.0% (1.7-2.3) of the patients. After 2 years (1.6-3.1), long-term MACE occurred in 17.4% (11.9-22.3), all-cause death in 8.7% (3.2-14.2), and MI in 7.8% (5.5-10.1) of the patients, whereas stent thrombosis and TVR in 3.4% (1.5-5.3) and 10.5% (7.5-13.4), respectively. In patients treated with drug-eluting stents (DES), the rate of long-term MACE was 22.3% (10.1-34.4), with an incidence of 4.9% (0.0-11.4) of MI and 5.7% (2.3-13.7, all 95% confidence intervals of TLR. INTERPRETATION HIV-positive patients have a high risk of in-hospital and long-term MACE after PCI, partially reduced by the use of DES. Further studies on the risk of recurrent ischemic events with current generation stents are needed, to offer a tailored therapy in this high-risk population.
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Affiliation(s)
- Mattia Peyracchia
- Division of Cardiology, Department of Internal Medicine, Città Della Salute e della Scienza, University of Turin, Turin, Italy
| | - Roberto Verardi
- Division of Cardiology, Department of Internal Medicine, Città Della Salute e della Scienza, University of Turin, Turin, Italy
| | - Sergio Raposeiras Rubin
- Department of Cardiology and Coronary Care Unit, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña
| | - Emad Abu-Assi
- Department of Cardiology, University Hospital Álvaro Cunqueiro, Vigo, Spain
| | | | - Leor Perl
- Cardiology Department, Rabin Medical Center, Petach-Tikva and the "Sackler" Faculty of Medicine, Tel-Aviv University, Israel
| | - Walter Grossomarra
- Division of Cardiology, Department of Internal Medicine, Città Della Salute e della Scienza, University of Turin, Turin, Italy
| | - Andrea Calcagno
- Division of Infectious Disease, University of Turin, Turin, Italy
| | - Pierluigi Omedè
- Division of Cardiology, Department of Internal Medicine, Città Della Salute e della Scienza, University of Turin, Turin, Italy
| | - Antonio Montefusco
- Division of Cardiology, Department of Internal Medicine, Città Della Salute e della Scienza, University of Turin, Turin, Italy
| | - Stefano Bonora
- Division of Infectious Disease, University of Turin, Turin, Italy
| | - Claudio Moretti
- Division of Cardiology, Department of Internal Medicine, Città Della Salute e della Scienza, University of Turin, Turin, Italy
| | - Maurizio D'Amico
- Division of Cardiology, Department of Internal Medicine, Città Della Salute e della Scienza, University of Turin, Turin, Italy
| | - Rinaldi Mauro
- Division of Cardiology, Department of Internal Medicine, Città Della Salute e della Scienza, University of Turin, Turin, Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Department of Internal Medicine, Città Della Salute e della Scienza, University of Turin, Turin, Italy
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Demir OM, Candilio L, Fuster D, Muga R, Barbaro G, Colombo A, Azzalini L. Cardiovascular disease burden among human immunodeficiency virus-infected individuals. Int J Cardiol 2019; 265:195-203. [PMID: 29885686 DOI: 10.1016/j.ijcard.2018.03.137] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 03/17/2018] [Accepted: 03/30/2018] [Indexed: 12/20/2022]
Abstract
Human Immunodeficiency Virus (HIV) infection affects 36.7 million people worldwide, it accounted for 1.1 million deaths in 2015. The advent of combined antiretroviral therapy (cART) has been associated with a decrease in HIV-related morbidity and mortality. However, there are increasing concerns about long-lasting effects of chronic inflammation and immune activation, leading to premature aging and HIV-related mortality. Cardiovascular diseases, especially coronary artery disease, are among the leading causes of death in HIV-infected patients, accounting for up to 15% of total deaths in high income countries. Furthermore, as cART availability expands to low-income countries, the burden of cardiovascular related mortality is likely to rise. Hence, over the next decade HIV-associated cardiovascular disease burden is expected to increase globally. In this review, we summarize our understanding of the pathogenesis and risk factors associated with HIV infection and cardiovascular disease, in particular coronary artery disease.
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Affiliation(s)
- Ozan M Demir
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy; Department of Cardiology, Hammersmith Hospital, Imperial College NHS Healthcare Trust, London, United Kingdom
| | - Luciano Candilio
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy; Department of Cardiology, Hammersmith Hospital, Imperial College NHS Healthcare Trust, London, United Kingdom
| | - Daniel Fuster
- Department of Internal Medicine, Addiction Unit, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Robert Muga
- Department of Internal Medicine, Addiction Unit, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Giuseppe Barbaro
- Department of Internal Medicine and Infectious Diseases, Policlinico Umberto Primo, Rome, Italy
| | - Antonio Colombo
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Lorenzo Azzalini
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy.
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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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10
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Feinstein MJ, Poole B, Engel Gonzalez P, Pawlowski AE, Schneider D, Provias TS, Palella FJ, Achenbach CJ, Lloyd-Jones DM. Differences by HIV serostatus in coronary artery disease severity and likelihood of percutaneous coronary intervention following stress testing. J Nucl Cardiol 2018; 25:872-883. [PMID: 27739037 PMCID: PMC5391305 DOI: 10.1007/s12350-016-0689-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 09/15/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND HIV-infected persons develop coronary artery disease (CAD) more commonly and earlier than uninfected persons; however, the role of non-invasive testing to stratify CAD risk in HIV is not well defined. METHODS AND RESULTS Patients were selected from a single-center electronic cohort of HIV-infected patients and uninfected controls matched 1:2 on age, sex, race, and type of cardiovascular testing performed. Patients with abnormal echocardiographic or nuclear stress testing who subsequently underwent coronary angiography were included. Logistic regressions were used to assess differences by HIV serostatus in two co-primary endpoints: (1) severe CAD (≥70% stenosis of at least one coronary artery) and (2) performance of percutaneous coronary intervention (PCI). HIV-infected patients (N = 189) were significantly more likely to undergo PCI following abnormal stress test when compared with uninfected persons (N = 319) after adjustment for demographics, CAD risk factors, previous coronary intervention, and stress test type (OR 1.85, 95% CI 1.12-3.04, P = 0.003). No associations between HIV serostatus and CAD were statistically significant, although there was a non-significant trend toward greater CAD for HIV-infected patients. CONCLUSIONS HIV-infected patients with abnormal cardiovascular stress testing who underwent subsequent coronary angiography did not have a significantly greater CAD burden than uninfected controls, but were significantly more likely to receive PCI.
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Affiliation(s)
- Matthew J Feinstein
- Division of Cardiovascular Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, 676 N. St. Clair, Suite 600, Chicago, IL, 60611, USA.
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N. Lakeshore Drive, Suite 1400, Chicago, IL, 60611, USA.
| | - Brian Poole
- Department of Medicine, Beth Israel Deaconness Medical Center, Boston, MA, USA
| | - Pedro Engel Gonzalez
- Department of Medicine, Northwestern University Feinberg School of Medicine, 251 E. Huron, Suite 3-150, Chicago, IL, 60611, USA
| | - Anna E Pawlowski
- Northwestern Medicine Enterprise Data Warehouse, Chicago, IL, 60611, USA
| | - Daniel Schneider
- Northwestern Medicine Enterprise Data Warehouse, Chicago, IL, 60611, USA
| | - Tim S Provias
- Division of Cardiovascular Diseases, Northwestern University Feinberg School of Medicine, 676 N. St. Clair, Suite 600, Chicago, IL, 60611, USA
| | - Frank J Palella
- Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, 251 E. Huron St., Suite 3-150, Chicago, IL, 60611, USA
| | - Chad J Achenbach
- Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, 251 E. Huron St., Suite 3-150, Chicago, IL, 60611, USA
| | - Donald M Lloyd-Jones
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N. Lakeshore Drive, Suite 1400, Chicago, IL, 60611, USA
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HIV status and type of coronary stent placed in patients presenting with ST-elevation myocardial infarction. Coron Artery Dis 2018; 28:239-245. [PMID: 28288008 DOI: 10.1097/mca.0000000000000488] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Drug-eluting stents (DES) outperform bare-metal stents (BMS) in reducing target vessel revascularization following a percutaneous coronary intervention (PCI). Little is known about the types of stents placed in HIV-positive patients presenting with ST-segment elevation myocardial infarctions (STEMIs). METHODS We used the 2003-2013 National Inpatient Sample to identify adults of 18 years or older presenting with STEMI. We evaluated differences in stent type placed following STEMIs on the basis of HIV status. Temporal trends in the use of PCI, DES, and BMS were studied on the basis of HIV status. RESULTS Of 1 695 947 patients with STEMI, 5887 (0.3%) were HIV-positive patients. Following STEMIs, HIV-positive patients were equally likely to have PCI compared with HIV-negative patients [adjusted odds ratio (AOR): 1.04, 95% confidence interval (CI): 0.89-1.21, P=0.63]. However, HIV-positive patients were less likely to have DES (AOR: 0.83, 95% CI: 0.73-0.94, P=0.003) and more likely to have BMS (AOR: 1.26, 95% CI: 1.11-1.45, P=0.001). Over the 11-year period observed, there were increases in PCI following STEMIs in both HIV-positive and HIV-negative patients (all Ptrend<0.001). There were significant increases in the use of DES in HIV-negative patients [adjusted odds ratio (AOR) per year: 1.07, 95% CI: 1.06-1.09, Ptrend<0.001] and significant decreases in the use of BMS (AOR per year: 0.93, 95% CI: 0.92-0.94, Ptrend<0.001). Significant trends showing changed practice patterns in the use of DES and BMS among HIV-positive patients were not observed. CONCLUSION Over a decade, there were significant increases in the use of PCI following STEMIs in both HIV-negative and HIV-positive patients. Although HIV-positive patients presenting with STEMIs were as likely as HIV-negative patients to undergo PCI, they were less likely to be treated with DES and more likely to receive BMS. Highlighting these observations will hopefully bring renewed attention to best practices for all STEMI patients.
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Kupková P, Heczko M, Kaučák V, Kryza R. HIV as a risk factor of coronary artery disease and of acute coronary syndrome. COR ET VASA 2017. [DOI: 10.1016/j.crvasa.2016.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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13
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Bundhun PK, Pursun M, Huang WQ. Does infection with human immunodeficiency virus have any impact on the cardiovascular outcomes following percutaneous coronary intervention?: a systematic review and meta-analysis. BMC Cardiovasc Disord 2017; 17:190. [PMID: 28716008 PMCID: PMC5514470 DOI: 10.1186/s12872-017-0624-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 07/12/2017] [Indexed: 11/27/2022] Open
Abstract
Background A direct link between human immunodeficiency virus (HIV)-infected patients and the risk of cardiovascular diseases (CVD) has been shown in recent scientific research. However, this issue is controversial since other previous reports showed no apparent impact of HIV or its anti-retroviral drugs on the cardiovascular system. We aimed to systematically compare the postinterventional adverse cardiovascular outcomes which were observed in patients with and without HIV infection during a mean follow up period ranging from 1 year to 3 years. Methods Common electronic databases were searched for studies which compared postinterventional adverse cardiovascular outcomes [mortality, myocardial infarction (MI), cardiac death, target vessel revascularization (TVR), target lesion revascularization (TLR), stroke and major adverse cardiac events (MACEs)] in patients with and without HIV infection. Statistical analysis was carried out by the RevMan 5.3 software whereby Odds Ratios (OR) and 95% Confidence Intervals (CIs) were generated. Results Two thousand two hundred and sixty-eight (2268) patients (821 patients were HIV positive and 1147 patients were HIV negative) were analyzed. The current results showed that mortality was not significantly increased among patients who were HIV positive with OR: 1.13, 95% CI: 0.65–1.96; P = 0.66. Cardiac death was also similarly reported with OR: 1.16, 95% CI: 0.50–2.68; P = 0.74. However, even if recurrent MI, TVR, TLR, MACEs and stroke were higher in patients who were HIV positive, with OR: 1.32, 95% CI: 0.88–2.12; P = 0.18, OR: 1.36, 95% CI: 0.88–2.12; P = 0.17, OR: 1.22, 95% CI: 0.72–2.06; P = 0.46, OR: 1.29, 95% CI: 0.89–1.85; P = 0.17 and OR: 1.47, 95% CI: 0.44–4.89; P = 0.53 respectively, these results were not statistically significant. Conclusion Patients who were infected with HIV had similar mortality post coronary intervention compared to patients who were not infected by the virus, during a mean follow-up period of 1–3 years. In addition, no significant increase in MI, TVR, TLR, MACEs and stroke were observed during this follow up period. Therefore, it might be concluded that no apparent impact of HIV on the cardiovascular outcomes was observed post coronary intervention.
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Affiliation(s)
- Pravesh Kumar Bundhun
- Institute of Cardiovascular Diseases, the First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, 530027, People's Republic of China
| | - Manish Pursun
- Guangxi Medical University, Nanning, Guangxi, 530027, People's Republic of China
| | - Wei-Qiang Huang
- Institute of Cardiovascular Diseases, the First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, 530027, People's Republic of China. .,Institute of Cardiovascular Diseases, the First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, 530021, People's Republic of China.
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14
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Carvalho AS, Osório Valente R, Almeida Morais L, Modas Daniel P, Sá Carvalho R, Ferreira L, Cruz Ferreira R. HIV and coronary disease - When secondary prevention is insufficient. Rev Port Cardiol 2017; 36:569.e1-569.e8. [PMID: 28697899 DOI: 10.1016/j.repc.2016.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 07/15/2016] [Accepted: 10/03/2016] [Indexed: 10/19/2022] Open
Abstract
Highly active antiretroviral therapy (HAART) has created a new paradigm for human immunodeficiency virus (HIV)-infected patients, but their increased risk for coronary disease is well documented. We present the case of a 57-year-old man, co-infected with HIV-2 and hepatitis B virus, adequately controlled and with insulin-treated type 2 diabetes and dyslipidemia, who was admitted with non-ST elevation acute myocardial infarction. Coronary angiography performed on day four of hospital stay documented two-vessel disease (mid segment of the right coronary artery [RCA, 90% stenosis] and the first marginal). Two drug-eluting stents were successfully implanted. The patient was discharged under dual antiplatelet therapy (aspirin 100 mg/day and clopidogrel 75 mg/day) and standard coronary artery disease medication. He was admitted to the emergency room four hours after discharge with chest pain radiating to the left arm and inferior ST-segment elevation myocardial infarction was diagnosed. Coronary angiography was performed within one hour and documented thrombosis of both stents. Optical coherence tomography revealed good apposition of the stent in the RCA, with intrastent thrombus. Angioplasty was performed, with a good outcome. The acute stent thrombosis might be explained by the thrombotic potential of HIV infection and diabetes. There are no specific guidelines regarding HAART in secondary prevention of acute coronary syndromes. A multidisciplinary approach is essential for optimal management of these patients.
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Affiliation(s)
- Ana Sofia Carvalho
- Serviço de Medicina Interna, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal.
| | | | - Luís Almeida Morais
- Serviço de Cardiologia, Hospital de Santa Marta, Centro Hospitalar Lisboa Central, Lisboa, Portugal
| | - Pedro Modas Daniel
- Serviço de Cardiologia, Hospital de Santa Marta, Centro Hospitalar Lisboa Central, Lisboa, Portugal
| | - Ramiro Sá Carvalho
- Serviço de Cardiologia, Hospital de Santa Marta, Centro Hospitalar Lisboa Central, Lisboa, Portugal
| | - Lurdes Ferreira
- Serviço de Cardiologia, Hospital de Santa Marta, Centro Hospitalar Lisboa Central, Lisboa, Portugal
| | - Rui Cruz Ferreira
- Serviço de Cardiologia, Hospital de Santa Marta, Centro Hospitalar Lisboa Central, Lisboa, Portugal
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15
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HIV and coronary disease – When secondary prevention is insufficient. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.repce.2016.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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16
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Ballocca F, D'Ascenzo F, Gili S, Grosso Marra W, Gaita F. Cardiovascular disease in patients with HIV. Trends Cardiovasc Med 2017; 27:558-563. [PMID: 28779949 DOI: 10.1016/j.tcm.2017.06.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 06/06/2017] [Accepted: 06/07/2017] [Indexed: 01/13/2023]
Abstract
With the progressive increase in life expectancy of HIV-positive patient, thanks to "highly active antiretroviral therapy" (HAART), new comorbidities, and especially cardiovascular diseases (CVDs) are emerging as an important concern. An increased risk of coronary artery disease, often in a younger age, has been observed in this population. The underlying pathophysiology is complex and partially still unclear, with the interaction of viral infection-and systemic inflammation-antiretroviral therapy and traditional risk factors. After an accurate risk stratification, primary prevention should balance the optimal HAART to suppress the virus-avoiding side-effects-the intervention on life-style and the treatment of traditional risk factors (hypertension, dyslipidemia, and diabetes). Also the management after a cardiovascular event is challenging: revascularization strategies-both percutaneous and surgical-are valuable options, keeping in mind the higher rates of recurrent events, and caution is essential to avoid drug-drug interactions. Large evidence-based data on HIV-infected patients are still lacking, and recommendations often follow those of general population. Therefore we performed a comprehensive evaluation of the literature to analyze the current knowledge on CVD's prevalence, prevention and treatment in HIV-infected patients.
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Affiliation(s)
- Flavia Ballocca
- Department of Medical Sciences, Città della Salute e della Scienza, Turin, Italy
| | - Fabrizio D'Ascenzo
- Department of Medical Sciences, Città della Salute e della Scienza, Turin, Italy.
| | - Sebastiano Gili
- Department of Medical Sciences, Città della Salute e della Scienza, Turin, Italy
| | - Walter Grosso Marra
- Department of Medical Sciences, Città della Salute e della Scienza, Turin, Italy
| | - Fiorenzo Gaita
- Department of Medical Sciences, Città della Salute e della Scienza, Turin, Italy
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Alkhalil M, Conlon CP, Ashrafian H, Choudhury RP. Aggressive restenosis after percutaneous intervention in two coronary loci in a patient with human immunodeficiency virus infection. World J Clin Cases 2017; 5:40-45. [PMID: 28255546 PMCID: PMC5314259 DOI: 10.12998/wjcc.v5.i2.40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 07/29/2016] [Accepted: 10/18/2016] [Indexed: 02/05/2023] Open
Abstract
A 54-year-old black African woman, 22 years human immunodeficiency virus (HIV)-positive, presented with an acute coronary syndrome. She was taking two nucleoside reverse transcriptase inhibitors and two protease inhibitors. Viral load and CD4 count were stable. Angiography revealed a right coronary artery lesion, which was treated with everolimus eluting stent. She also underwent balloon angioplasty to the first diagonal. She re-presented on three different occasions and technically successful coronary intervention was performed. The patient has reported satisfactory compliance with dual anti platelet therapy throughout. She was successfully treated with surgical revascularisation. The patient did not experience any clinical recurrence on follow up. This case demonstrates exceptionally aggressive multifocal and recurrent instent restenosis in a patient treated for HIV infection, raising the possibility of an association with HIV infection or potentially components of retro viral therapy.
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18
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Vachiat A, McCutcheon K, Tsabedze N, Zachariah D, Manga P. HIV and Ischemic Heart Disease. J Am Coll Cardiol 2017; 69:73-82. [DOI: 10.1016/j.jacc.2016.09.979] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 08/25/2016] [Accepted: 09/20/2016] [Indexed: 10/20/2022]
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19
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d’Ettorre G, Ceccarelli G, Pavone P, Vittozzi P, De Girolamo G, Schietroma I, Serafino S, Giustini N, Vullo V. What happens to cardiovascular system behind the undetectable level of HIV viremia? AIDS Res Ther 2016; 13:21. [PMID: 27127532 PMCID: PMC4848790 DOI: 10.1186/s12981-016-0105-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 04/14/2016] [Indexed: 11/08/2022] Open
Abstract
Despite the combined antiretroviral therapy has improved the length and quality of life of HIV infected patients, the survival of these patients is always decreased compared with the general population. This is the consequence of non-infectious illnesses including cardio vascular diseases. In fact large studies have indicated an increased risk of coronary atherosclerotic disease, myocardial infarction even in HIV patients on cART. In HIV infected patients several factors may contribute to the pathogenesis of cardiovascular problems: life-style, metabolic parameters, genetic predisposition, viral factors, immune activation, chronic inflammation and side effects of antiretroviral therapy. The same factors may also contribute to complicate the clinical management of these patients. Therefore, treatment of these non-infectious illnesses in HIV infected population is an emerging challenge for physicians. The purpose of this review is to focus on the new insights in non AIDS-related cardiovascular diseases in patients with suppressed HIV viremia.
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Shah MR, Cook N, Wong R, Hsue P, Ridker P, Currier J, Shurin S. Stimulating high impact HIV-related cardiovascular research: recommendations from a multidisciplinary NHLBI Working Group on HIV-related heart, lung, and blood disease. J Am Coll Cardiol 2015; 65:738-44. [PMID: 25677433 DOI: 10.1016/j.jacc.2014.12.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 12/09/2014] [Indexed: 12/30/2022]
Abstract
The clinical challenges confronting patients with human immunodeficiency virus (HIV) have shifted from acquired immunodeficiency syndrome (AIDS)-related illnesses to chronic diseases, such as coronary artery disease, chronic lung disease, and chronic anemia. With the growing burden of HIV-related heart, lung, and blood (HLB) disease, the National Heart, Lung, and Blood Institute (NHLBI) recognizes it must stimulate and support HIV-related HLB research. Because HIV offers a natural, accelerated model of common pathological processes, such as inflammation, HIV-related HLB research may yield important breakthroughs for all patients with HLB disease. This paper summarizes the cardiovascular recommendations of an NHLBI Working Group, Advancing HIV/AIDS Research in Heart, Lung, and Blood Diseases, charged with identifying scientific priorities in HIV-related HLB disease and developing recommendations to promote multidisciplinary collaboration among HIV and HLB investigators. The working group included multidisciplinary sessions, as well as HLB breakout sessions for discussion of disease-specific issues, with common themes about scientific priorities and strategies to stimulate HLB research emerging in all 3 groups.
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Affiliation(s)
- Monica R Shah
- National Heart, Lung, and Blood Institute, Bethesda, Maryland.
| | - Nakela Cook
- National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Renee Wong
- National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Priscilla Hsue
- Division of Cardiology, University of California-San Francisco School of Medicine, San Francisco, California
| | - Paul Ridker
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard University School of Medicine, Boston, Massachusetts
| | - Judith Currier
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, California
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Carballo D, Delhumeau C, Carballo S, Bähler C, Radovanovic D, Hirschel B, Clerc O, Bernasconi E, Fasel D, Schmid P, Cusini A, Fehr J, Erne P, Keller PF, Ledergerber B, Calmy A. Increased mortality after a first myocardial infarction in human immunodeficiency virus-infected patients; a nested cohort study. AIDS Res Ther 2015; 12:4. [PMID: 25705241 PMCID: PMC4336509 DOI: 10.1186/s12981-015-0045-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 02/02/2015] [Indexed: 12/12/2022] Open
Abstract
AIMS HIV infection may be associated with an increased recurrence rate of myocardial infarction. Our aim was to determine whether HIV infection is a risk factor for worse outcomes in patients with coronaray artery disease. METHODS We compared data aggregated from two ongoing cohorts: (i) the Acute Myocardial Infarction in Switzerland (AMIS) registry, which includes patients with acute myocardial infarction (AMI), and (ii) the Swiss HIV Cohort Study (SHCS), a prospective registry of HIV-positive (HIV+) patients. We included all patients who survived an incident AMI occurring on or after 1st January 2005. Our primary outcome measure was all-cause mortality at one year; secondary outcomes included AMI recurrence and cardiovascular-related hospitalisations. Comparisons used Cox and logistic regression analyses, respectively. RESULTS There were 133 HIV+, (SHCS) and 5,328 HIV-negative [HIV-] (AMIS) individuals with incident AMI. In the SHCS and AMIS registries, patients were predominantly male (72% and 85% male, respectively), with a median age of 51 years (interquartile range [IQR] 46-57) and 64 years (IQR 55-74), respectively. Nearly all (90%) of HIV+ individuals were on successful antiretroviral therapy. During the first year of follow-up, 5 (3.6%) HIV+ and 135 (2.5%) HIV- individuals died. At one year, HIV+ status after adjustment for age, sex, calendar year of AMI, smoking status, hypertension and diabetes was associated with a higher risk of death (HR 4.42, 95% CI 1.73-11.27). There were no significant differences in recurrent AMIs (4 [3.0%] HIV+ and 146 [3.0%] HIV- individuals, OR 1.16, 95% CI 0.41-3.27) or in hospitalization rates (OR 0.68 [95% CI 0.42-1.11]). CONCLUSIONS HIV infection was associated with a significantly increased risk of all-cause mortality one year after incident AMI.
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Beltrán LM, Rubio-Navarro A, Amaro-Villalobos JM, Egido J, García-Puig J, Moreno JA. Influence of immune activation and inflammatory response on cardiovascular risk associated with the human immunodeficiency virus. Vasc Health Risk Manag 2015; 11:35-48. [PMID: 25609975 PMCID: PMC4293933 DOI: 10.2147/vhrm.s65885] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Patients infected with the human immunodeficiency virus (HIV) have an increased cardiovascular risk. Although initially this increased risk was attributed to metabolic alterations associated with antiretroviral treatment, in recent years, the attention has been focused on the HIV disease itself. Inflammation, immune system activation, and endothelial dysfunction facilitated by HIV infection have been identified as key factors in the development and progression of atherosclerosis. In this review, we describe the epidemiology and pathogenesis of cardiovascular disease in patients with HIV infection and summarize the latest knowledge on the relationship between traditional and novel inflammatory, immune activation, and endothelial dysfunction biomarkers on the cardiovascular risk associated with HIV infection.
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Affiliation(s)
- Luis M Beltrán
- Metabolic-Vascular Unit, Fundación IdiPAZ-Hospital Universitario La Paz, Madrid, Spain
| | - Alfonso Rubio-Navarro
- Vascular, Renal, and Diabetes Research Lab, IIS-Fundación Jiménez Díaz, Madrid, Spain
| | | | - Jesús Egido
- Vascular, Renal, and Diabetes Research Lab, IIS-Fundación Jiménez Díaz, Madrid, Spain ; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, Spain ; Fundación Renal Iñigo Alvarez de Toledo-Instituto Reina Sofía de Investigaciones Nefrológicas (FRIAT-IRSIN), Madrid, Spain
| | - Juan García-Puig
- Metabolic-Vascular Unit, Fundación IdiPAZ-Hospital Universitario La Paz, Madrid, Spain
| | - Juan Antonio Moreno
- Vascular, Renal, and Diabetes Research Lab, IIS-Fundación Jiménez Díaz, Madrid, Spain
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Fanari Z, Hammami S, Hammami MB, Weintraub WS, Qureshi WA. Acute Coronary Syndrome In HIV Naïve Patient With Low CD4 Count And No Other Significant Risk Factors: Case Report And Literature Review. OPEN JOURNAL OF CLINICAL & MEDICAL CASE REPORTS 2015; 1:1009. [PMID: 26065032 PMCID: PMC4459740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Coronary artery disease (CAD) has become the leading cause of mortality in patients with Human Immunodeficiency Virus (HIV). The typical HIV-infected patient presenting with acute coronary syndrome (ACS) is a man in his mid to late 40s. The most common presentation is an acute myocardial infarction (MI), most often with ST segment elevation. Coronary anatomy seems to be variable, with some studies showing a higher prevalence of single-vessel disease and others showing a higher prevalence of 2- and 3-vessel disease than in controls not infected with HIV.
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Affiliation(s)
- Zaher Fanari
- Department of Cardiology, Christian Care Health System, Newark, Delaware
| | - Sumaya Hammami
- Department of Cardiology, Christian Care Health System, Newark, Delaware
| | | | | | - Wasif A. Qureshi
- Department of Cardiology, Christian Care Health System, Newark, Delaware
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Badr S, Minha S, Kitabata H, Fatemi O, Torguson R, Suddath WO, Satler LF, Pichard AD, Waksman R. Safety and long-term outcomes after percutaneous coronary intervention in patients with human immunodeficiency virus. Catheter Cardiovasc Interv 2014; 85:192-8. [DOI: 10.1002/ccd.25466] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Revised: 02/12/2014] [Accepted: 02/25/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Salem Badr
- Section of Interventional Cardiology, MedStar Heart Institute, MedStar Washington Hospital Center; Washington District of Columbia
| | - Sa'ar Minha
- Section of Interventional Cardiology, MedStar Heart Institute, MedStar Washington Hospital Center; Washington District of Columbia
| | - Hironori Kitabata
- Section of Interventional Cardiology, MedStar Heart Institute, MedStar Washington Hospital Center; Washington District of Columbia
| | - Omid Fatemi
- Section of Interventional Cardiology, MedStar Heart Institute, MedStar Washington Hospital Center; Washington District of Columbia
| | - Rebecca Torguson
- Section of Interventional Cardiology, MedStar Heart Institute, MedStar Washington Hospital Center; Washington District of Columbia
| | - William O. Suddath
- Section of Interventional Cardiology, MedStar Heart Institute, MedStar Washington Hospital Center; Washington District of Columbia
| | - Lowell F. Satler
- Section of Interventional Cardiology, MedStar Heart Institute, MedStar Washington Hospital Center; Washington District of Columbia
| | - Augusto D. Pichard
- Section of Interventional Cardiology, MedStar Heart Institute, MedStar Washington Hospital Center; Washington District of Columbia
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Heart Institute, MedStar Washington Hospital Center; Washington District of Columbia
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D'Ascenzo F, Cerrato E, Appleton D, Moretti C, Calcagno A, Abouzaki N, Vetrovec G, Lhermusier T, Carrie D, Das Neves B, Escaned J, Cassese S, Kastrati A, Chinaglia A, Belli R, Capodanno D, Tamburino C, Santilli F, Parodi G, Vachiat A, Manga P, Vignali L, Mancone M, Sardella G, Fedele F, DiNicolantonio JJ, Omedè P, Bonora S, Gaita F, Abbate A, Zoccai GB. Prognostic indicators for recurrent thrombotic events in HIV-infected patients with acute coronary syndromes: use of registry data from 12 sites in Europe, South Africa and the United States. Thromb Res 2014; 134:558-64. [PMID: 25064035 DOI: 10.1016/j.thromres.2014.05.037] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 05/26/2014] [Accepted: 05/27/2014] [Indexed: 02/08/2023]
Abstract
AIMS Limited data are available on prognostic indicators for HIV patients presenting with ACS. METHODS AND RESULTS Data on consecutive patients with HIV infection receiving standard highly active antiretroviral therapy (HAART) presenting with ACS between January 2001 and September 2012 were collected. Cardiac death and myocardial infarction (MI) were the primary end-points. 10,050 patients with ACS were screened, and among them a total of 201 patients (179 [89%] males and a median age of 53 [47-62] years) were included, 48% of them admitted for ST-elevation myocardial infarction and 14% having left ventricular systolic dysfunction (LVSD) at discharge. CD4+ counts less than 200 cells/mm(3) were reported in 18 patients (9%), and 136 patients (67%) were treated with nucleoside-reverse transcriptase inhibitors (NRTI). After a median of 24 months (10-41), 30 patients (15%) died, 12 (6%) for cardiac reasons, 20 (10%) suffered a MI, 29 (15%) a subsequent revascularization, and 7 (3%) a stent thrombosis. Other than LVSD (hazard ratio=6.4 [95% confidence interval [CI]: 1.6-26: p=0.009]), the only other independent predictor of cardiac death was not being treated with NRTI (hazard ratio=9.9 [95% CI: 2.1-46: p=0.03); a CD4 cell count <200 cells/mm(3) was the only predictor of MI (hazard ratio=5.9 [95% CI: 1.4-25: p=0.016]). CONCLUSIONS HIV patients presenting with ACS are at significantly increased risk for cardiac death if not treated with NRTI, and at significantly increased risk of MI if their CD4 cell count is <200 cells/mm(3), suggesting that the stage of HIV disease (and lack of NRTI treatment) may contribute to cardiovascular instability.
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Affiliation(s)
- Fabrizio D'Ascenzo
- Division of Cardiology, Città della Salute e della Scienza "Molinette" Hospital, University of Turin, Turin, Italy
| | - Enrico Cerrato
- Division of Cardiology, Città della Salute e della Scienza "Molinette" Hospital, University of Turin, Turin, Italy; Division of Cardiology, Hospital Clinico San Carlos, Madrid, Spain
| | | | - Claudio Moretti
- Division of Cardiology, Città della Salute e della Scienza "Molinette" Hospital, University of Turin, Turin, Italy
| | - Andrea Calcagno
- Division of Cardiology, Maria VittoriaHospital, Turin, Italy; Division of Infectious Disease, Amedeo di Savoia Hospital, Turin, Italy
| | | | | | | | - Didier Carrie
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Italy
| | | | - Javier Escaned
- Division of Cardiology, Hospital Clinico San Carlos, Madrid, Spain
| | | | | | - Alessandra Chinaglia
- Division of Cardiology, Maria VittoriaHospital, Turin, Italy; Division of Infectious Disease, Amedeo di Savoia Hospital, Turin, Italy
| | - Riccardo Belli
- Division of Cardiology, Maria VittoriaHospital, Turin, Italy
| | | | - Corrado Tamburino
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Italy
| | - Francesca Santilli
- Division of Cardiology, Università degli Studi 'G. d'Annunzio' Chieti e Pescara, Italy
| | - Guido Parodi
- Division of Cardiology, Università degli Studi 'G. d'Annunzio' Chieti e Pescara, Italy; Division of Cardiology, Careggi Hospital, Florence, Italy
| | - Ahmed Vachiat
- University of Witwatersrand Charlotte Maxeke Johannesburg Academic Hospital, Division of Cardiology
| | - Pravin Manga
- University of Witwatersrand Charlotte Maxeke Johannesburg Academic Hospital, Division of Cardiology
| | - Luigi Vignali
- Department of Cardiology, University of Parma, Italy
| | - Massimo Mancone
- Department of Cardiovascular and Pulmonary Sciences, Policlinico Umberto I "Sapienza", University of Rome, Italy
| | - Gennaro Sardella
- Department of Cardiovascular and Pulmonary Sciences, Policlinico Umberto I "Sapienza", University of Rome, Italy
| | - Francesco Fedele
- Division of Cardiology, Città della Salute e della Scienza "Molinette" Hospital, University of Turin, Turin, Italy
| | | | - Pierluigi Omedè
- Division of Cardiology, Città della Salute e della Scienza "Molinette" Hospital, University of Turin, Turin, Italy
| | - Stefano Bonora
- Division of Infectious Disease, Amedeo di Savoia Hospital, Turin, Italy
| | - Fiorenzo Gaita
- Division of Cardiology, Città della Salute e della Scienza "Molinette" Hospital, University of Turin, Turin, Italy
| | | | - Giuseppe Biondi Zoccai
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy.
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Mavroudis CA, Majumder B, Loizides S, Christophides T, Johnson M, Rakhit RD. Coronary artery disease and HIV; getting to the HAART of the matter. Int J Cardiol 2013; 167:1147-53. [DOI: 10.1016/j.ijcard.2012.09.043] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Accepted: 09/15/2012] [Indexed: 11/30/2022]
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Cardiac effects in perinatally HIV-infected and HIV-exposed but uninfected children and adolescents: a view from the United States of America. J Int AIDS Soc 2013; 16:18597. [PMID: 23782480 PMCID: PMC3687072 DOI: 10.7448/ias.16.1.18597] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Accepted: 04/16/2013] [Indexed: 12/14/2022] Open
Abstract
Introduction Human immunodeficiency virus (HIV) infection is a primary cause of acquired heart disease, particularly of accelerated atherosclerosis, symptomatic heart failure, and pulmonary arterial hypertension. Cardiac complications often occur in late-stage HIV infections as prolonged viral infection is becoming more relevant as longevity improves. Thus, multi-agent HIV therapies that help sustain life may also increase the risk of cardiovascular events and accelerated atherosclerosis. Discussion Before highly active antiretroviral therapy (HAART), the two-to-five-year incidence of symptomatic heart failure ranged from 4 to 28% in HIV patients. Patients both before and after HAART also frequently have asymptomatic abnormalities in cardiovascular structure. Echocardiographic measurements indicate left ventricular (LV) systolic dysfunction in 18%, LV hypertrophy in 6.5%, and left atrial dilation in 40% of patients followed on HAART therapy. Diastolic dysfunction is also common in long-term survivors of HIV infection. Accelerated atherosclerosis has been found in HIV-infected young adults and children without traditional coronary risk factors. Infective endocarditis, although rare in children, has high mortality in late-stage AIDS patients with poor nutritional status and severely compromised immune systems. Although lymphomas have been found in HIV-infected children, the incidence is low and cardiac malignancy is rare. Rates of congenital cardiovascular malformations range from 5.6 to 8.9% in cohorts of HIV-uninfected and HIV-infected children with HIV-infected mothers. In non-HIV-infected infants born to HIV-infected mothers, foetal exposure to ART is associated with reduced LV dimension, LV mass, and septal wall thickness and with higher LV fractional shortening and contractility during the first two years of life. Conclusions Routine, systematic, and comprehensive cardiac evaluation, including a thorough history and directed laboratory assays, is essential for the care of HIV-infected adults and children as cardiovascular illness has become a part of care for long-term survivors of HIV infection. The history should include traditional risk factors for atherosclerosis, prior opportunistic infections, environmental exposures, and therapeutic and illicit drug use. Laboratory tests should include a lipid profile, fasting glucose, and HIV viral load. Asymptomatic cardiac disease related to HIV can be fatal, and secondary effects of HIV infection often disguise cardiac symptoms, so systematic echocardiographic monitoring is warranted.
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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.
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Affiliation(s)
- Franck Boccara
- Department of Cardiology, Saint Antoine Hospital, University of Paris, Paris, France.
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Martin A, Emery S. Metabolic disorders and cardiovascular consequences of HIV infection and antiretroviral therapy. Expert Rev Clin Pharmacol 2012; 2:381-90. [PMID: 22112182 DOI: 10.1586/ecp.09.11] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Metabolic disturbances associated with HIV disease have become an important factor in patient management and have important implications for long-term outcomes, both in regards to mortality and healthcare burden. Recent research has implicated both HIV infection itself and specific antiretroviral therapies in the development of these disorders. This review examines recent findings from research into insulin and glucose dysregulation, serum lipid abnormalities, adipose tissue and derangements in bone metabolism. This review then describes the cardiovascular consequences and management of these metabolic disorders, and summarizes current thinking on the pathogenesis and effects of antiretroviral therapy. Finally, the review raises some questions regarding ongoing challenges and unmet needs in this field of research.
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Affiliation(s)
- Allison Martin
- National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Level 2, 376 Victoria St, Darlinghurst, NSW 2010, Australia.
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D'Ascenzo F, Cerrato E, Biondi-Zoccai G, Moretti C, Omedè P, Sciuto F, Bollati M, Modena MG, Gaita F, Sheiban I. Acute coronary syndromes in human immunodeficiency virus patients: a meta-analysis investigating adverse event rates and the role of antiretroviral therapy. Eur Heart J 2011; 33:875-80. [PMID: 22187508 DOI: 10.1093/eurheartj/ehr456] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
AIMS Highly active antiretroviral therapy (HAART) dramatically reduces human immunodeficiency virus (HIV)-associated morbidity and mortality, but adverse effects of HAART are becoming an increasing challenge, especially in the setting of acute coronary syndromes (ACS). We thus performed a comprehensive review of studies focusing on ACS in HIV patients. METHODS AND RESULTS MEDLINE/PubMed was systematically screened for studies reporting on ACS in HIV patients. Baseline, treatment, and outcome data were appraised and pooled with random-effect methods computing summary estimates [95% confidence intervals (CIs)]. A total of 11 studies including 2442 patients were identified, with a notably low prevalence of diabetes [10.86 (4.11, 17.60); 95% CI]. Rates of in-hospital death were 8.00% (2.8, 12.5; 95% CI), ascribable to cardiovascular events for 7.90% (2.43, 13.37; 95% CI), with 2.31% (0.60, 4.01; 95% CI) developing cardiogenic shock. At a median follow-up of 25.50 months (11.25, 42; 95% CI), no deaths were recorded, with an incidence of 9.42% of acute myocardial infarction (2.68, 16.17; 95% CI) and of 20.18% (9.84, 30.51; 95% CI) of percutaneous coronary revascularization. Moreover, pooled analysis of the studies reporting incidence of acute myocardial infarction in patients exposed to protease inhibitors showed an overall significant risk of 2.68 (odds ratio 1.89, 3.89; 95% CI). CONCLUSION Human immunodeficiency virus patients admitted for ACS face a substantial short-term risk of death and a significant long-term risk of coronary revascularization and myocardial infarction, especially if receiving protease inhibitors.
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Affiliation(s)
- Fabrizio D'Ascenzo
- Division of Cardiology, University of Turin, S. Giovanni Battista 'Molinette' Hospital, Corso Bramante 88-90, Turin 10126, Italy.
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Fisher SD, Kanda BS, Miller TL, Lipshultz SE. Cardiovascular Disease and Therapeutic Drug-Related Cardiovascular Consequences in HIV-Infected Patients. Am J Cardiovasc Drugs 2011; 11:383-394. [DOI: 10.2165/11594590-000000000-00000] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Dau B, Holodniy M. The Relationship Between HIV Infection and Cardiovascular Disease. Curr Cardiol Rev 2011; 4:203-18. [PMID: 19936197 PMCID: PMC2780822 DOI: 10.2174/157340308785160589] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2008] [Revised: 05/23/2008] [Accepted: 05/23/2008] [Indexed: 12/25/2022] Open
Abstract
Over 30 million people are currently living with human immunodeficiency virus (HIV) infection, and over 2 million new infections occur per year. HIV has been found to directly affect vascular biology resulting in an increased risk of cardiovascular disease compared to uninfected persons. Although HIV infection can now be treated effectively with combination antiretroviral medications, significant toxicities such as hyperlipidemia, diabetes, and excess cardiovascular co-morbidity; as well as the potential for significant drug-drug interactions between HIV and cardiovascular medications, present new challenges for the management of persons infected with HIV. We first review basic principles of HIV pathogenesis and treatment and then discuss relevant clinical management strategies that will be useful for cardiologists who might be involved in the care of HIV infected patients.
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Affiliation(s)
- Birgitt Dau
- VA Palo Alto Health Care System and Division of Infectious Diseases and Geographic Medicine, Stanford University, Palo Alto, CA, USA
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Ceccarelli G, d'Ettorre G, Mancone M, Francone M, Vullo V. Accelerated coronary atherosclerosis after execution of percutaneous coronary intervention in patient with HIV/HCV coinfection: case report and review of the literature. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2011; 12:262-5. [PMID: 21273145 DOI: 10.1016/j.carrev.2010.11.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Accepted: 11/23/2010] [Indexed: 12/30/2022]
Abstract
Highly active antiretroviral therapy has greatly reduced AIDS-related morbidity and mortality; however, its widespread use has been associated with a marked rise in the frequency of cardiovascular diseases in patients with HIV. Moreover, HIV infection is associated with accelerated coronary atherosclerosis and vasculopathy, although the mechanisms underlying these findings have not been determined. We describe the case of a 45-year-old woman with HIV/HCV coinfection, irritable bowel syndrome, and accelerated progression of coronary atherosclerosis after execution of percutaneous coronary intervention (PCI). In this case, the rapidity of progression of atherosclerosis seems linked principally to chronic inflammation and excess immune activation that can depend by a concourse of factors (chronic C hepatitis, irritable bowel syndrome, PCI execution) not directly associated with traditional risk factors. Caregivers following HIV-infected patients should be aware of the increased risk of accelerated atherogenesis in these subjects, principally in case of presence of causes of intense immune activation.
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Affiliation(s)
- Giancarlo Ceccarelli
- Department of Infectious Diseases and Public Health, University of Rome Sapienza, Italy.
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Boccara F. Acute coronary syndrome in HIV-infected patients. Does it differ from that in the general population? Arch Cardiovasc Dis 2010; 103:567-9. [PMID: 21147440 DOI: 10.1016/j.acvd.2010.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2010] [Accepted: 10/21/2010] [Indexed: 10/18/2022]
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Boccara F, Mary-Krause M, Teiger E, Lang S, Lim P, Wahbi K, Beygui F, Milleron O, Gabriel Steg P, Funck-Brentano C, Slama M, Girard PM, Costagliola D, Cohen A. Acute coronary syndrome in human immunodeficiency virus-infected patients: characteristics and 1 year prognosis. Eur Heart J 2010; 32:41-50. [PMID: 20965887 DOI: 10.1093/eurheartj/ehq372] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIMS Natural history and prognosis of acute coronary syndrome (ACS) in HIV-infected patients remain to be determined. We sought to compare coronary risk factors, angiographic features, acute results of percutaneous coronary intervention, in-hospital outcomes, and pre-specified 1 year prognosis of HIV-infected and HIV-uninfected patients with ACS. METHODS AND RESULTS HIV-infected and HIV-uninfected patients with a first episode of ACS were matched for age (±5 years), sex, and type of ACS. The primary endpoint was the rate of major adverse cardiac and cerebral events (MACCE), comprising cardiac death, recurrent ACS, recurrent coronary revascularization, and stroke. Overall, 103 HIV-infected and 195 HIV-uninfected patients were enrolled (mean age 49.0 ± 9.4 years, 94% men). Coronary risk factors were well balanced, but HIV-infected patients more frequently used illicit drugs (23 vs. 6%, P = 0.001) and had higher triglyceride concentrations (246 ± 189 vs. 170 ± 139 mg/dL, P = 0.002) compared with HIV-uninfected patients. Angiographic features of coronary artery disease were similar (multivessel disease 41 vs. 39%, P = 0.96; ACC/AHA type culprit lesion ≥B2, both 77%, P = 0.83). At 1 year, the rate of occurrence of first MACCE did not differ between groups [hazard ratio (HR) 1.4, 95% CI 0.6-3.0]. Recurrent ACS was more frequent in HIV-infected patients (HR 6.5, 95% CI 1.7-23.9) with no difference in the rate of clinical restenosis. CONCLUSIONS These results suggest that the acute management of ACS in HIV-infected patients can routinely be the same as that of HIV-uninfected patients, but that specific secondary prevention measures are needed to alleviate the increased risk of recurrent ACS.
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Affiliation(s)
- Franck Boccara
- Department of Cardiology, Saint Antoine Hospital, 184 rue du faubourg St-Antoine, Univ-Paris 6, Paris, France
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Martín-Reyes R, Galeote G, Moreno R, Sánchez-Recalde A, López De Sá E, López-Sendón JL. [Percutaneous coronary intervention in HIV infected patients with human immunodeficiency virus admitted with acute coronary syndrome: case-control study]. Med Clin (Barc) 2010; 135:691-4. [PMID: 20599234 DOI: 10.1016/j.medcli.2010.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2010] [Revised: 05/04/2010] [Accepted: 05/06/2010] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Human immunodeficiency virus (HIV) has been linked in recent years with a higher rate of cardiovascular events. The aim of our study was to analyze the main risk factors associated with the onset of an acute coronary syndrome (ACS) and in-hospital prognosis in patients with HIV, undergoing percutaneous coronary intervention (PCI). PATIENTS AND METHODS We studied the baseline clinical characteristics, angiographic findings, results of PCI and in-hospital outcome in 23 patients with HIV hospitalized for an ACS between September 2006 and March 2009. The results were compared with 60 HIV-negative patients admitted with an ACS. RESULTS HIV patients showed a lower average age and a higher rate of smoking. From a clinical point of view there were no statistically significant differences in clinical presentation, with a similar incidence of ACS with or without ST segment elevation ACS. HIV patients presented a non significant higher incidence of cardiogenic shock on admission (13% HIV vs 8% HIV negative, p 0,301). HIV-negative patients angiography showed the most calcified multivessel involvement with the highest number of diseased vessels (2.35 vs. 1.45, p<0.001). PCI results: HIV patients presented a lower rate of success (TIMI 3 final); 75% versus 85% in HIV-negative patients (p=0.105). There was no significant difference in hospital mortality (8.7 vs 1.7%, p=0.129). CONCLUSIONS HIV patients hospitalized for an ACS, despite being younger and presenting lower prevalence of traditional cardiovascular risk factors, did not present differences in terms of cardiovascular mortality compared with HIV negative patients.
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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.
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Affiliation(s)
- Rakesh K Mishra
- Berkeley Cardiovascular Medical Group, 2450 Ashby Avenue, Berkeley, CA 94705, USA.
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Abstract
PURPOSE OF REVIEW Antiretroviral (ARV) therapy has altered the course of HIV disease and dramatically increased the lifespan of HIV-infected individuals. Accumulating evidence, however, suggests that prolonged ARV use contributes to metabolic and cardiovascular changes. Understanding the toxicities of ARV treatment and sequelae of long-term infection is critical. This review will examine recent evidence related to vascular dysfunction and cardiovascular complications in HIV infection. RECENT FINDINGS Recent studies investigating circulating markers of inflammation, surrogate markers of subclinical atherosclerotic disease, and novel imaging modalities suggest the presence of endothelial dysfunction in HIV-infected patients. In addition, data from several recently updated cohort studies confirm an association between ARV therapy and cardiovascular events. SUMMARY New data suggest that cardiovascular disease is increased among HIV-infected patients receiving highly active ARV therapy. The mechanisms of increased cardiovascular disease may relate to direct effects of the HIV virus and inflammation on the vasculature or to toxicities from specific ARV therapies, which may increase traditional cardiovascular risk factors. Understanding and modifying these risks and preventing cardiovascular events are critical to the long-term management of the HIV-infected patient.
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Monsuez JJ, Charniot JC, Escaut L, Teicher E, Wyplosz B, Couzigou C, Vignat N, Vittecoq D. HIV-associated vascular diseases: Structural and functional changes, clinical implications. Int J Cardiol 2009; 133:293-306. [DOI: 10.1016/j.ijcard.2008.11.113] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2008] [Revised: 11/04/2008] [Accepted: 11/26/2008] [Indexed: 12/14/2022]
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Cardiovascular complications and atherosclerotic manifestations in the HIV-infected population: type, incidence and associated risk factors. AIDS 2008; 22 Suppl 3:S19-26. [PMID: 18845918 DOI: 10.1097/01.aids.0000327512.76126.6e] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Before the introduction of successful antiretroviral therapy (ART), cardiovascular complications in HIV-infected patients were largely those resulting from immunosuppression (e.g. myocarditis, pericarditis, tamponade). With the advent of ART, there has been a spectacular decrease in morbidity and mortality in HIV-infected individuals. However, alongside metabolic complications caused by ART such as insulin resistance, dyslipidemia and lipodystrophy syndrome have been observed, which potentially increase the risk of cardiovascular complications, in particular coronary artery disease. Whether HIV infection and ART are independent and individual coronary risk factors is still controversial. More and more data are available demonstrating that increasing the duration of exposure to ART, and in particular protease inhibitors, increases the risk of myocardial infarction. At the same time, chronic infection, inflammation and the disruption of immune balance as a result of HIV infection itself may have the potential to alter vascular structure and function. In this article, we will review cardiovascular complications in HIV-infected patients before and after the advent of ART, focusing on coronary artery disease, its diagnosis, prognosis and therapy.
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