Chapter

Cardiac disease in HIV infection

Peter F. Currie

in Oxford Textbook of Medicine

Fifth edition

Published on behalf of Oxford University Press

ISBN: 9780199204854
Published online May 2012 | e-ISBN: 9780199570973 | DOI: http://dx.doi.org/10.1093/med/9780199204854.003.160903_update_001

Series: Oxford Textbooks

Cardiac disease                 in HIV infection

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Symptomatic heart disease can affect up to 10% of HIV-positive patients and cause death in around 2%. Echocardiographic screening is recommended.

In resource-poor countries where access to antiretroviral drugs is limited the typical manifestations are (1) HIV heart-muscle disease—this occurs in the late stages of HIV infection, with dilated cardiomyopathy having a dismal prognosis, the median survival after diagnosis being about 100 days; angiotensin converting enzyme (ACE) inhibitors and β-blockers may produce unacceptable side effects; and (2) pericardial effusion—a common finding, but most are symptomless; significant effusions are often due to mycobacterial infection or malignant infiltration, particularly with non-Hodgkin’s lymphoma.

In the developed world premature coronary artery disease is more common in patients with HIV than in controls. There is a two- to threefold increase in the incidence of acute coronary events in HAART-treated HIV patients, which is thought to be related to HIV lipodystrophy, an ill-defined syndrome that resembles the non-HIV metabolic syndrome and is found in up to 35% of patients after 12 months of protease inhibitor therapy. Isolated pulmonary hypertension is a rare, non-infectious complication of HIV infection and has a grave prognosis (50% survival at 1 year). Highly active antiretroviral therapy (HAART) and specific pulmonary hypertension therapies may be beneficial.

Sudden death due to cardiac-rhythm abnormalities is well recognized in HIV infection and may account for 20% of cardiac-related deaths.

Chapter.  2749 words.  Illustrated.

Subjects: Cardiovascular Medicine

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