Cardiac diseases in AIDS overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Raviteja Guddeti, M.B.B.S. [2]
Overview
Increasing incidence of HIV/AIDS has made it the fourth leading cause of death worldwide. Moreover, introduction of HAART in treating patients infected with HIV has improved survival. Increasingly higher number of this subgroup is found to be suffering from a heart disease, which is a direct effect of decreased mortality. A recent study found about 24% of patients infected with HIV to have a cardiac condition[1].
Pathophysiology
Many observational studies have shown that HIV-infected patients are at an increased risk for developing a variety of cardiac diseases. With the introduction of HAART, longevity of HIV-infected patients increased, in turn leading to increased prevalence of cardiac and allied diseases. Inflammation and immune regulation leading to atherogenesis, endothelial dysfunction and coagulation abnormalities have been proposed as the major factors in the pathogenesis of cardiovascular diseases in AIDS. Compared to age-matched uninfected controls, HIV-infected patients have a higher risk of myocardial infarction (MI) and cardiovascular death, even with effective anti-retroviral therapy. Concerns have been raised about HAART by itself is associated with increased risk of peripheral (PAD) and coronary artery disease (CAD) [2].
Epidemiology and Demographics
Incidence of many cardiovascular diseases has reduced after the induction of anti-retroviral therapy in the treatment of HIV infection.
Diagnosis
History and Symptoms
Pericarditis is the most common clinical manifestation of cardiovascular disease in patients with AIDS. However, majority of the cases of pericardial effusion are asymptomatic and are found incidentally on a chest x-ray showing increased cardiac silhouette. Symptoms vary with the type of cardiac disease in AIDS.
Electrocardiogram
In an analysis of 4518 HIV-infected patients it was found that more than half of the participants (51.5%) had either minor or major ECG abnormalities. Minor ECG abnormalities (48.6%) were more common than major ECG abnormalities (7.7%) [3].
Imaging
Chest X-Ray
Chest X ray abnormalities in HIV infected patients are seen in presence of congestive cardiac failure and pericardial effusions. These include cardiomegaly and pulmonary congestion.
Echocardiography
Echocardiography is the most specific test for diagnosing the degree of systolic LV dysfunction in HIV infected patients with cardiomyopathy. Common findings include effusions and ventricular dysfunction.
Other Diagnostic Studies
Endomyocardial biopsy under the guidance of an echocardiography may be required to diagnose the potentially treatable causes of myocarditis and cardiomyopathy.
Treatment
Medical Therapy
If the patient is not on antiretroviral therapy, medical therapy for cardiac diseases in HIV infected patients requires co-ordination of care between cardiology and infectious disease department, in order to formulate an individualized treatment plan based on risk factors. Drug therapy for cardiac diseases in HIV patients is same as that for the general population, except for consideration for interactions of these drugs with HAART. Moreover, the benefits of HAART outweighs the risk of interactions with cardiac drugs. However, cardiotoxic drugs need to be discontinued.
Surgery
Unless the patient has advanced immunosuppression or is at high risk for mortality from HIV related complications, cardiaovascular surgical procedures like vale replacement and coronary artery bypass can be performed safely.
Prevention
Statins and aspirin have shown to reduce mortality from CVD in general population, but their use in HIV infected population is uncertain.
References
- ↑ Cammarosano C, Lewis W (1985). "Cardiac lesions in acquired immune deficiency syndrome (AIDS)". Journal of the American College of Cardiology. 5 (3): 703–6. PMID 3973269. Unknown parameter
|month=ignored (help) - ↑ Barbaro G, Fisher SD, Lipshultz SE (2001). "Pathogenesis of HIV-associated cardiovascular complications". The Lancet Infectious Diseases. 1 (2): 115–24. doi:10.1016/S1473-3099(01)00067-6. PMID 11871462. Unknown parameter
|month=ignored (help) - ↑ Soliman EZ, Prineas RJ, Roediger MP; et al. (2011). "Prevalence and prognostic significance of ECG abnormalities in HIV-infected patients: results from the Strategies for Management of Antiretroviral Therapy study". Journal of Electrocardiology. 44 (6): 779–85. doi:10.1016/j.jelectrocard.2010.10.027. PMC 3060290. PMID 21145066.