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Cardiac disease in HIV infection 

Cardiac disease in HIV infection

Chapter:
Cardiac disease in HIV infection
Author(s):

Peter F. Currie

DOI:
10.1093/med/9780199204854.003.160903_update_002

Update:

Management – comments on cardiac transplantation, and on potential interaction between clopidogrel and etravirine.

Updated on 27 Nov 2014. The previous version of this content can be found here.
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date: 26 March 2017

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 HIV patients treated with highly active antiretroviral therapy (HAART), 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, noninfectious complication of HIV infection and has a grave prognosis (50% survival at 1 year). 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.

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