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Acute coronary syndrome in patients with human immunodeficiency virus disease
Nirav J Mehta1, Ijaz A Khan, Rajal N Mehta
1Department of Medicine, Creighton University School of Medicine, Omaha, NE 68131-2044, USA.
Insights
Coronary artery disease (CAD) is emerging as a complication in patients with human immunodeficiency virus (HIV), even without traditional risk factors. This study highlights the association between HIV infection and premature CAD, suggesting a need for increased cardiovascular monitoring.
Area of Science:
- Cardiology
- Infectious Diseases
- Public Health
Background:
- Noninfectious conditions, including cardiac manifestations, are increasingly recognized in human immunodeficiency virus (HIV)-infected patients due to improved survival.
- Cardiac involvement in HIV ranges from asymptomatic to fatal, with known manifestations including pericarditis, myocarditis, and pulmonary hypertension.
- Coronary artery disease (CAD) was not previously considered a common complication of HIV infection.
Observation:
- This study reviewed 10 cases of acute coronary syndrome in HIV-infected patients over seven years.
- These patients lacked typical CAD risk factors, with smoking being the only common comorbidity.
- CAD was confirmed via angiography or autopsy in all identified cases.
Findings:
- The mean CD4 count was 380 cells/mm3, and CAD occurred a mean of 7.5 years after HIV diagnosis.
- Patients presented with varying degrees of CAD, including single-vessel (4 patients), two-vessel (1 patient), and three-vessel disease (5 patients).
- Treatment interventions included coronary bypass surgery in three patients, and one patient experienced cardiogenic shock.
Implications:
- Coronary artery disease may be an under-recognized complication associated with HIV infection.
- The findings suggest a potential link between HIV and accelerated atherogenesis, possibly influenced by treatments like protease inhibitors.
- Increased cardiovascular surveillance may be warranted for HIV-infected individuals, particularly those with a history of smoking.
Abstract:
With more effective prophylactic treatment and an increased time of survival, noninfectious conditions associated with human immunodeficiency virus (HIV) disease are being recognized with increasing frequency in HIV patients. Cardiac involvement in HIV-infected patients varies from clinically silent to a fatal disease with a direct cardiac cause of mortality estimated at 1% to 6%. Pericardial effusion, pericarditis, myocarditis, cardiomyopathy, endocarditis, and pulmonary hypertension are known cardiac manifestations associated with HIV infection. Coronary artery disease (CAD) has not been a recognized complication of HIV disease, although some recent case reports have suggested occurrence of premature CAD and accelerated atherogenesis in HIV-infected patients. The role of protease inhibitors have been suggested in the development of this complication. After reviewing records of the last 7 years, the authors found 10 cases of acute coronary syndrome in HIV-infected patients who had no other risk factor for CAD except smoking. The presence of CAD was confirmed by angiography or autopsy. The mean CD4 count was 380 cells/mm3, and the mean duration between the diagnosis of HIV infection and CAD was 7.5 years. Four patients had single-vessel disease, 1 patient had 2-vessel disease, and 5 patients had 3-vessel disease. Three patients underwent coronary bypass surgery and 1 patient died of cardiogenic shock. CAD may be associated with HIV disease.