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Cardiac morbidity in the human immunodeficiency virus infection
J S Cardoso1, A M Miranda, B Moura
1Hospitalar de Cardiologia do Hospital de S. João e Assistente da Faculdade de Medicina do Porto.
Insights
Cardiac involvement is common in Human Immunodeficiency Virus (HIV) infection, with echocardiography revealing frequent subclinical abnormalities. Advanced HIV stages and lower CD4 counts correlate with increased cardiac issues.
Area of Science:
- Cardiology
- Infectious Diseases
- Virology
Background:
- Human Immunodeficiency Virus (HIV) infection can affect multiple organ systems.
- Cardiac complications are a significant concern in patients with HIV, impacting morbidity and mortality.
- Understanding the spectrum and prevalence of cardiac involvement is crucial for patient management.
Purpose of the Study:
- To evaluate the extent and nature of cardiac involvement in patients with Human Immunodeficiency Virus (HIV) infection.
- To assess the frequency of clinical and subclinical cardiac abnormalities using echocardiography.
- To identify factors associated with cardiac involvement in HIV-infected individuals.
Main Methods:
- A prospective, controlled study involving 137 HIV-infected patients and 40 healthy controls.
- Clinical assessment and comprehensive echocardiographic evaluations were performed.
- Data were analyzed based on HIV stage, CD4+ lymphocyte counts, and viral subtypes (HIV-1 vs. HIV-2).
Main Results:
- Subclinical cardiac abnormalities were detected in 75.9% of HIV patients via echocardiography.
- Increased left ventricular (LV) dimensions and reduced LV function were observed in the HIV population.
- Cardiac involvement, including LV dysfunction and pericardial effusion, was more prevalent in advanced HIV stages and lower CD4+ counts.
Conclusions:
- Subclinical cardiac involvement is frequent in HIV infection, often detectable by echocardiography.
- Cardiac abnormalities are more common in advanced HIV disease and with lower CD4+ lymphocyte counts.
- While clinical symptoms are rare, echocardiographic findings highlight the significant subclinical cardiac impact of HIV infection.
Purpose:
To evaluate the cardiac involvement in Human Immunodeficiency Virus (HIV) infection.
Design:
Prospective and normal individuals group controlled study.
Setting:
The departments of cardiology and infectious diseases of an university hospital.
Patients:
137 consecutive HIV infected patients at all stages of the infection and 40 normal noninfected controls.
Measurements And Main Results:
Clinical and echocardiographic evaluation was performed. Cardiac symptoms were observed in 10 (7.3%) patients, manifested as congestive heart failure. The global HIV infected population had increased left ventricular (LV) dimensions and wall thickness and decreased LV fractional shortening and ejection fraction when compared with the control population. Seven (5.1%) patients had dilated cardiomyopathy, 9 (6.5%) had global LV hypokinesis with or without LV dilatation and 17 (12.4%) had segmental LV wall motion abnormalities. Right ventricular dilatation was present in 23 (16.8%). Mitral or tricuspid regurgitation of a moderate or severe degree was found in 3 (2.2%) patients. No valvular vegetations were found. Fifty nine (43.1%) patients presented a pericardial effusion. An echocardiogram with at least one abnormality was observed in 104 (75.9%) and a severely abnormal echocardiogram in 34 (24.8%). The presence of cardiac symptoms and of abnormal and severely abnormal echocardiograms was more frequent in patients with the acquired immunodeficiency syndrome than in asymptomatic HIV infected patients. When comparing HIV-1 with HIV-2 populations the first showed increased LV systolic and diastolic diameters and LV mass index. There was no statistically significant difference between all risk behavior groups regarding the frequency of cardiac symptoms or the echocardiographic abnormalities found. HIV infected patients with CD4+ lymphocytes counts < or = 100/mm3 had more frequent abnormal and severely abnormal echocardiograms than those with CD4+ lymphocytes counts > 100/mm3.
Conclusions:
Although cardiac symptoms were rare in our population, subclinical cardiac involvement detected by echocardiography was frequent and could involve any cardiac layer. It was not influenced by the patients' risk behavior. The left ventricular trophic response observed in HIV-2 infection seemed less intense than that in HIV-1 infection. Cardiac involvement was more frequent in the more advanced stages of the infection and in patients with lower CD4+ lymphocyte counts.