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Heart Disease in Patients with HIV/AIDS-An Emerging Clinical Problem.

Gopal M, Bhaskaran A, Khalife WI, Barbagelata A - Curr Cardiol Rev (2009)

Bottom Line: Patients with HIV/AIDS and symptoms suggestive of cardiac disease represent a diagnostic and therapeutic challenge in clinical practice; Cardiologists are more frequently encountering this problem.An algorithmic, anatomic approach to diagnosis, localizing disease to the endocardium, myocardium and pericardium can be useful.Treatment of cardiac disease, in HIV/AIDS patients can vary from non-HIV patients, based on drug interactions, differences in responsiveness, and other factors; and this area requires further research.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, University of Texas Medical Branch (UTMB), 301, University Boulevard, Galveston, TX-77550, USA.

ABSTRACT
HIV/AIDS (Human immunodeficiency virus/ Acquired immuno deficiency syndrome) is a growing global problem, in terms of its incidence and mortality. Patients with HIV/AIDS are living much longer with HAART (Highly active antiretroviral therapy) therapy so much so that HIV/AIDS has now become a part of the chronic disease burden, like hypertension and diabetes. Patients with HIV/AIDS and symptoms suggestive of cardiac disease represent a diagnostic and therapeutic challenge in clinical practice; Cardiologists are more frequently encountering this problem. An algorithmic, anatomic approach to diagnosis, localizing disease to the endocardium, myocardium and pericardium can be useful. An intimate knowledge of opportunistic infections affecting the heart, effects of HAART therapy and therapy for opportunistic infections on the heart is needed to be able to formulate a differential diagnosis. Effects of HAART therapy, especially protease inhibitors on lipid and glucose metabolism, and their influence on progression to premature vascular disease require consideration. Treatment of cardiac disease, in HIV/AIDS patients can vary from non-HIV patients, based on drug interactions, differences in responsiveness, and other factors; and this area requires further research.

No MeSH data available.


Related in: MedlinePlus

An algorithmic approach to cardiac problems in HIV/AIDS.
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Figure 1: An algorithmic approach to cardiac problems in HIV/AIDS.

Mentions: The history and physical examination must be used to detect symptoms and signs of cardiovascular disease in patients with HIV/AIDS. The history must include details of previous opportunistic infections, traditional risk factors for atherosclerosis, details regarding present and prior anti-retroviral therapy. One of the important questions clinicians should ask themselves is whether an HIV-positive individual is immunocompetent or immunodeficient- on the basis of a recent CD4 count and if not available, this would be necessary for further diagnostic evaluation and decisions regarding treatment and prognosis (see Fig. (1) for algorithm). If the patient is not already on anti-retroviral therapy and presents with cardiac symptoms, this may require referral to an infectious disease specialist for decision making regarding anti-retroviral therapy. Co-ordination of care between infectious disease and cardiology can improve the quality of care and aid in developing an individualized treatment plan based on all of the above factors. Routine use of electrocardiography or echocardiography in these patients is discouraged, especially because of the lack of evidence for finding sub-clinical disease. Shortness of breath is a common complaint, and in patients with HIV/AIDS, requires consideration of cardiomyopathy and pulmonary hypertension as possible etiologies. Transthoracic echocardiography is required for further evaluation. Drug therapy of for heart failure is not different from HIV-negative individuals, except for consideration of drug-drug interactions, especially with anti-retroviral therapy. Endomyocardial biopsy may be needed in HIV/AIDS patients with ventricular dysfunction on echocardiography to identify potentially treatable causes of myocarditis/cardiomyopathy. Lastly, cardiotoxic medications may need to be stopped in patients who have pre-existing or those who have developed significant cardiovascular disease. Management of pericardial disease, especially tuberculous effusions, is different in this patient population: addition of steroids is indicated and pericardiocentesis is needed even in the absence of tamponade. Treatment of endocarditis does not differ from HIV negative individuals. In this new era of significantly improved prognosis in patients with HIV/AIDS, both cardiac procedures and cardiovascular surgery, including valve replacement and coronary artery bypass grafting should be done in these patients, except in the setting of advanced immunosuppression or high risk of mortality from AIDS- related complications. Increased incidence of coronary artery disease, peripheral vascular disease and deep venous thrombosis has been shown in this patient population and requires careful consideration of the adverse effects of the different classes of anti-retroviral therapy.


Heart Disease in Patients with HIV/AIDS-An Emerging Clinical Problem.

Gopal M, Bhaskaran A, Khalife WI, Barbagelata A - Curr Cardiol Rev (2009)

An algorithmic approach to cardiac problems in HIV/AIDS.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2805817&req=5

Figure 1: An algorithmic approach to cardiac problems in HIV/AIDS.
Mentions: The history and physical examination must be used to detect symptoms and signs of cardiovascular disease in patients with HIV/AIDS. The history must include details of previous opportunistic infections, traditional risk factors for atherosclerosis, details regarding present and prior anti-retroviral therapy. One of the important questions clinicians should ask themselves is whether an HIV-positive individual is immunocompetent or immunodeficient- on the basis of a recent CD4 count and if not available, this would be necessary for further diagnostic evaluation and decisions regarding treatment and prognosis (see Fig. (1) for algorithm). If the patient is not already on anti-retroviral therapy and presents with cardiac symptoms, this may require referral to an infectious disease specialist for decision making regarding anti-retroviral therapy. Co-ordination of care between infectious disease and cardiology can improve the quality of care and aid in developing an individualized treatment plan based on all of the above factors. Routine use of electrocardiography or echocardiography in these patients is discouraged, especially because of the lack of evidence for finding sub-clinical disease. Shortness of breath is a common complaint, and in patients with HIV/AIDS, requires consideration of cardiomyopathy and pulmonary hypertension as possible etiologies. Transthoracic echocardiography is required for further evaluation. Drug therapy of for heart failure is not different from HIV-negative individuals, except for consideration of drug-drug interactions, especially with anti-retroviral therapy. Endomyocardial biopsy may be needed in HIV/AIDS patients with ventricular dysfunction on echocardiography to identify potentially treatable causes of myocarditis/cardiomyopathy. Lastly, cardiotoxic medications may need to be stopped in patients who have pre-existing or those who have developed significant cardiovascular disease. Management of pericardial disease, especially tuberculous effusions, is different in this patient population: addition of steroids is indicated and pericardiocentesis is needed even in the absence of tamponade. Treatment of endocarditis does not differ from HIV negative individuals. In this new era of significantly improved prognosis in patients with HIV/AIDS, both cardiac procedures and cardiovascular surgery, including valve replacement and coronary artery bypass grafting should be done in these patients, except in the setting of advanced immunosuppression or high risk of mortality from AIDS- related complications. Increased incidence of coronary artery disease, peripheral vascular disease and deep venous thrombosis has been shown in this patient population and requires careful consideration of the adverse effects of the different classes of anti-retroviral therapy.

Bottom Line: Patients with HIV/AIDS and symptoms suggestive of cardiac disease represent a diagnostic and therapeutic challenge in clinical practice; Cardiologists are more frequently encountering this problem.An algorithmic, anatomic approach to diagnosis, localizing disease to the endocardium, myocardium and pericardium can be useful.Treatment of cardiac disease, in HIV/AIDS patients can vary from non-HIV patients, based on drug interactions, differences in responsiveness, and other factors; and this area requires further research.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, University of Texas Medical Branch (UTMB), 301, University Boulevard, Galveston, TX-77550, USA.

ABSTRACT
HIV/AIDS (Human immunodeficiency virus/ Acquired immuno deficiency syndrome) is a growing global problem, in terms of its incidence and mortality. Patients with HIV/AIDS are living much longer with HAART (Highly active antiretroviral therapy) therapy so much so that HIV/AIDS has now become a part of the chronic disease burden, like hypertension and diabetes. Patients with HIV/AIDS and symptoms suggestive of cardiac disease represent a diagnostic and therapeutic challenge in clinical practice; Cardiologists are more frequently encountering this problem. An algorithmic, anatomic approach to diagnosis, localizing disease to the endocardium, myocardium and pericardium can be useful. An intimate knowledge of opportunistic infections affecting the heart, effects of HAART therapy and therapy for opportunistic infections on the heart is needed to be able to formulate a differential diagnosis. Effects of HAART therapy, especially protease inhibitors on lipid and glucose metabolism, and their influence on progression to premature vascular disease require consideration. Treatment of cardiac disease, in HIV/AIDS patients can vary from non-HIV patients, based on drug interactions, differences in responsiveness, and other factors; and this area requires further research.

No MeSH data available.


Related in: MedlinePlus