Curriculum in CardiologyCardiovascular disease in HIV infection
Section snippets
Pericarditis
Pericardial effusion is frequently seen in asymptomatic HIV-infected patients. Large effusion causing tamponade is rare. HAART has considerably decreased the incidence of pericarditis and pericardial effusion (Table I),5 which are often caused by tuberculosis in patients with HIV infection. Associated myocarditis is present in up to a third of cases.6 Mortality is high, particularly in the presence of pericardial effusion. Pericardiocentesis is essential for the diagnosis and specific therapy,
HIV and pulmonary hypertension
Primary pulmonary hypertension, first described in hemophilic HIV-infected patients, occurs with a frequency of approximately 0.5% in patients with HIV infection, whereas the general yearly incidence is only approximately 1 to 2 per 1 million people.18 There is no relation to the disease stage as reflected by CD4 counts. Although repetitive opportunistic pulmonary infections can cause right ventricular dysfunction, that is, cor pulmonale, there is no association with the incidence of pulmonary
Aneurysmatic vascular disease
Cerebral artery aneurysms are frequent in children vertically infected with HIV. In adults, a number of case reports describe aneurysms of the aorta and peripheral and cerebrovascular arteries sometimes necessitating surgical repair.27 These aneurysms may be as a result of vasculitic changes induced by the virus,28 or by other infectious causes such as cytomegalovirus and tuberculosis. However, an infective agent is not always identified.28
Epidemiology
Sporadic case reports raising concerns about premature coronary artery disease in patients treated with HAART led to retrospective analysis of large cohort studies.
Previous studies have reached conflicting conclusions whether the incidence of myocardial infarction (MI) is indeed increased in this patient population. Although some investigators found an association,29 others did not.30
In 700 HIV-infected patients treated with HAART, 9 patients (1.3%) had acute coronary events after an average
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The pericardium and its diseases
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