Related Experiment Videos
[Cardiac side effects of anti-HIV agents]
J J Monsuez1, B Gallet, L Escaut
1Service de médecine interne, hôpital Paul-Brousse, Villejuif.
Insights
Highly active antiretroviral therapy (HAART) has shifted cardiac complications in HIV-1 patients from infections to drug side effects. Early intervention and lifestyle changes improve prognosis for these cardiac issues.
Area of Science:
- Cardiology
- Infectious Diseases
- Pharmacology
Context:
- The advent of highly active antiretroviral therapy (HAART) has significantly altered the landscape of cardiac complications in Human Immunodeficiency Virus-1 (HIV-1) infected patients.
- Opportunistic cardiac infections have become less prevalent, with drug-induced side effects now a primary etiological concern.
Purpose:
- To review the changing nature of cardiac complications in HIV-1 patients undergoing HAART.
- To highlight the diagnostic challenges and etiological roles of various drug classes in iatrogenic cardiac dysfunction.
- To discuss the management and prognosis of coronary complications associated with HAART.
Summary:
- Cardiac complications in HIV-1 patients have shifted from opportunistic infections to adverse drug reactions due to HAART.
- Drug-induced conditions include Torsades de Pointes, myocardial dysfunction, cardiomyopathy, and coronary artery disease, often linked to specific antiretroviral agents and protease inhibitors.
- Diagnosis can be challenging, especially for progressive cardiomyopathy, which requires differentiation from HIV-related or other causes.
- Coronary complications, particularly in smokers with hyperlipidemia, necessitate lipid management and smoking cessation for improved medium-term prognosis after myocardial infarction.
Impact:
- Understanding these drug-induced cardiac risks is crucial for optimizing HAART regimens and patient management.
- This knowledge aids clinicians in differentiating iatrogenic cardiac issues from disease progression or other comorbidities.
- Effective management strategies, including lifestyle modification and lipid control, can improve outcomes for HIV-1 patients experiencing cardiovascular events.
Abstract:
Both nature and prognosis of cardiac complications occurring in patients infected by the Human Immunodeficiency Virus-1 (HIV-1) have changed considerably since the introduction of highly acive and anti-retroviral triple therapy ("HART"). Opportunist cardiac infections have thus been displaced and side effects of drugs now occupy the primary aetiological role. Torsades de pointe may be exceptionally triggered by anti-infectious agents such as pentacarinat or trimethoprime-sulfamethoxazole, as are those induced by the association of ketoconazole and terfenadine or cisapride, the dangers of which are well known and the prevention more effective, especially with the association with HIV antiproteases which inhibit the cytochrome P450. The diagnosis of iatrogenic myocardial dysfunction is more difficult, except when it occurs acutely as with phosphonoformate (Foscarnet), or interleukine-2. Progressive cardiomyopathy caused by -interferon and dideoxynucleosides (zidovudine, didanosine and zalcitabine), reversible on withdrawal of the drug responsible in half the cases, should be distinguished from those due to the HIV itself (therapeutic relay) or to another associated cause (alcohol, coronary artery disease). The coronary complications of diseases treated by antiproteases usually occur in smokers whose cholesterol and triglyceride levels are rapidly increased with HAART. In a series of 9 patients (amongst 700 treated with the antiproteases), after the acute phase of myocardial infarction during which the interventional approach is often preferred, the medium-term prognosis is relatively good, on condition that the patients correct the hyperlipidaemia and give up smoking.