Cardiovascular Disease in AIDS

171 Pages·2005·4.483 MB·English

by  G. Barbaro (auth.), Giuseppe Barbaro, Franck Boccara (eds.)

Cardiovascular Disease in AIDS
Giuseppe Barbaro - Franck Boccara (Eds)
Cardiovascular Disease
in AIDS
Foreword by
W.Rozenbaum
1 3
GIUSEPPEBARBARO FRANCKBOCCARA
Department of Medical Pathophysiology Department of Cardiology
University “La Sapienza” Saint Antoine University Hospital
Rome,Italy Assistance Publique - Hôpitaux de Paris
and Université Paris VI
Paris,France
The Editors and Authors wish to thank Gilead Sciences for its generous contribution to this book.
Library ofCongress Control Number:2004117149
ISBN 88-470-0309-1 Springer Milan Berlin Heidelberg New York
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Foreword
Never in the history of humanity has knowledge It is particularly difficult to devise a therapeu-
progressed as quickly as in the field ofAIDS.Over tic strategy under these conditions,especially since
a period of 15 years,successive discoveries of the the efficacy of the usual lipid- or glucose-modify-
disease, its viral origin, the virus responsible, its ing medication is not established,and the benefit
physiopathology and highly effective therapies of any eventual correction of such biological
have led to spectacular improvement in life anomalies in this population is unclear.The issue
expectancy and in the quality oflife ofpeople who is further complicated by the many drug interac-
have access to these treatments. tions between antiretroviral medications and med-
However, this progress in therapy has been ications likely to act on the lipid metabolism,
accompanied by initially unforeseeable anomalies, which renders their usage complex.
such as abnormalities in lipid and glucose metabo- In this atmosphere of uncertainty, the simple
lism and modifications in fat distribution,particu- measure of diminishing tobacco usage is itself dif-
larly in perivisceral and trunkal accumulation as ficult,and overconsumption oftobacco is regularly
well as pseudo-obesity usually accompanied by observed in this population.
peripheral atrophy. The medical management of HIV-infected
Several of these anomalies constitute risk fac- patients is mostly carried out by infectious disease
tors for cardiovascular diseases and may be predic- specialists,and the field of cardiovascular diseases
tors of these diseases. Over time, most investiga- is not usually familiar to them.
tors have come to accept that HIV-infected patients The history of AIDS has taught us that phe-
are at an increased risk for cardiovascular compli- nomena are most quickly and effectively under-
cations. stood when light is cast on them from a variety of
However,several issues remain unclear: angles, using a variety of tools. The dynamism
• Does the increased risk merely reflect modifi- which has always characterized AIDS research will
cation ofthe usual factors:metabolic disorders, doubtless benefit from greater comprehension of
tobacco consumption, infectious context relat- the mechanisms of these poorly understood meta-
ed to HIV infection or opportunistic infections, bolic disorders.
inappropriate immune and cytokine response, The present volume contributes to disseminat-
or genetic background? ing knowledge in the field so that the various
• The physiopathology of disorders in glucose or actors can pool their expertise towards a successful
lipid metabolism remains to be clarified. It is management of cardiovascular disease in
unclear whether they result from treatment,use HIV-infected patients.
of a specific medication, use of a therapeutic
class of medication,or an association of treat- Willy Rozenbaum,MD
ments.Here,too,genetic background may well Professor ofInfectious Diseases
be a factor,along with the history of the indi- Pierre and Marie Curie University
vidual’s HIV infection. Paris,France
Contents
Evolution and Pathogenesis ofthe Involvement ofthe Cardiovascular System in HIV Infection
G.BARBARO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Pathogenesis ofHAART-Associated Metabolic Syndrome
J.CAPEAU . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Pathology ofCardiac Complications in HIV Infection
G.BARBARO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Pathology ofPeripheral and Coronary Vessels in AIDS Patients
A.TABIB,R.LOIRE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Coronary Heart Disease in HIV-Infected Patients:Epidemiology
M.MARY-KRAUSE,D.COSTAGLIOLA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Coronary Artery Disease in HIV-Infected Patients:Clinical Presentation,
Pathophysiology,Prognosis,Prevention,and Treatment
F.BOCCARA,A.COHEN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
Cerebrovascular Disease in HIV-Infected Patients
A.MOULIGNIER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
Peripheral Arterial Disease in HIV-Infected Patients:
Atherosclerosis and Vasculitic Syndromes
P.MERCIÉ,B.LEBAIL,C.CIPRIANO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
HIV-Associated Pulmonary Hypertension
G.BARBARO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
Coagulative Disorders in HIV-Infected Patients
L.DROUET . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
Cardiovascular Complications in HIV-Infected Children
D.BONNET . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
Cardiac Surgery and the Human Immunodeficiency Virus
N.BONNET,P.LEPRINCE,S.VARNOUS,I.GANDJBAKHCH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
Cardiological Emergencies in HIV-Infected Patients
G.BARBARO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133
VIII Contents
Guidelines for the Prevention ofCardiovascular Risk in HIV-Infected Patients
Treated with Antiretroviral Drugs
D.SCEVOLA,G.BARBARINI,G.BARBARO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143
Appendix 1
Cardiovascular Monitoring ofHIV-Infected Subjects and Cardiovascular Risk Stratification
and Primary Prevention ofCardiovascular Disease in Patients Receiving HAART
According to the Pavia Consensus Statement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155
Appendix 2
Interactions Between Antiretrovirals and Drugs Commonly Used to Treat
Cardiovascular Diseases According to the Pavia Consensus Statement . . . . . . . . . . . . . . . . . . . . . . . . . . . 161
Subject Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167
Contributors
Giorgio Barbarini Claire Cipriano
Department ofInfectious and Tropical Diseases, Service de Médecine Interne et Maladies
Policlinico San Matteo, Infectieuses,
University ofPavia,Italy Hôpital Haut-Lévêque,
E-mail:[email protected] Centre Hospitalier Universitaire de Bordeaux,
Bordeaux,France
Giuseppe Barbaro E-mail:[email protected]
Department ofMedical Pathophysiology,
University “La Sapienza”, Ariel Cohen
Rome,Italy Department ofCardiology,
E-mail:[email protected]
Saint Antoine University Hospital,
Assistance Publique - Hôpitaux de Paris and
Franck Boccara
Université Paris VI,Paris,France
Department ofCardiology,
E-mail:[email protected]
Saint Antoine University Hospital,
Assistance Publique - Hôpitaux de Paris and
Dominique Costagliola
Université Paris VI,Paris,France
INSERM EMI 0214,
E-mail:[email protected]
Paris,France
E-mail:[email protected]
Damien Bonnet
Service de Cardiologie Pédiatrique,
Ludovic Drouet
Hôpital Necker Enfants Malades,
Laboratoire de Thrombose et d’Athérosclérose,
Paris,France
Hôpital Lariboisière,
E-mail:[email protected]
Paris,France
E-mail:[email protected]
Nicolas Bonnet
Service de Chirurgie Cardio-vasculaire et
Iradj Gandjbakhch
Thoracique,
Service de Chirurgie Cardio-vasculaire et
Institut de Cardiologie,
Thoracique,
Groupe Hospitalier Pitié-Salpêtrière,
Paris,France Institut de Cardiologie,
E-mail:[email protected] Groupe Hospitalier Pitié-Salpêtrière,
Paris,France
Jacqueline Capeau E-mail:[email protected]
INSERM U402,
Faculty ofMedicine Saint-Antoine Brigitte Le Bail
and Department ofBiochemistry Tenon Hospital, Service d’Anatomie et Cytologie Pathologiques,
University Pierre and Marie Curie, Groupe Hospitalier Pellegrin-Enfants,
Paris,France Centre Hospitalier Universitaire de Bordeaux,
E-mail:[email protected] Bordeaux,France
X Contributors
Pascal Leprince Antoine Moulignier
Service de Chirurgie Cardio-vasculaire et Fondation Adolphe de Rothschild,
Thoracique, Service de Neurologie,
Institut de Cardiologie, Paris,France
Groupe Hospitalier Pitié-Salpêtrière, E-mail:[email protected]
Paris,France
E-mail:[email protected] Daniele Scevola
Department ofInfectious and Tropical Diseases,
Robert Loire Policlinico San Matteo,
Institut de Médecine Légale de Lyon, University ofPavia,
Lyon,France Pavia,Italy
E-mail:[email protected]
Murielle Mary-Krause
INSERM EMI 0214, Alain Tabib
Paris,France Institut de Médecine Légale de Lyon,
E-mail:[email protected] Lyon,France
E-mail:[email protected]
Patrick Mercié
Service de Médecine Interne, Shaida Varnous
Hôpital Saint-André, Service de Chirurgie Cardio-vasculaire et
Centre Hospitalier Universitaire de Bordeaux and Thoracique,
INSERM U593, Institut de Cardiologie,
Université Victor Segalen Bordeaux 2, Groupe Hospitalier Pitié-Salpêtrière,
Bordeaux,France Paris,France
E-mail:[email protected] E-mail:[email protected]
Evolution and Pathogenesis of the Involvement of the
Cardiovascular System in HIV Infection
G.Barbaro
Introduction dinal, multicenter study, diagnostic echocardio-
grams were performed at 4- to 6-month intervals
Cardiac illness related to human immunodeficiency on two cohorts of children exposed to maternal
virus (HIV) infection tends to occur late in the dis- HIV-1 infection: (a) a neonatal cohort of 90 HIV-
ease course and is therefore becoming more preva- infected,449 HIV-uninfected,and 19 HIV-indeter-
lent as therapy of the viral infection and longevity minate children; and (b) an older HIV-infected
improve.Autopsy series and retrospective analyses cohort of 201 children with vertically transmitted
performed before the introduction of highly active HIV-1 infection recruited after 28 days of age [3].
antiretroviral therapy (HAART) regimens suggest In the neonatal cohort,36 lesions were seen in 36
that cardiac lesions are present in 25%–75% of patients,yielding an overall congenital cardiovas-
patients with acquired immunodeficiency syndrome cular malformation prevalence of 6.5% (36/558),
(AIDS) [1]. HAART regimens have significantly with an 8.9% (8/90) prevalence in HIV-infected
modified the course ofHIV disease,with longer sur- children and a 5.6% (25/449) prevalence in HIV-
vival rates and improvement of life quality in HIV- uninfected children [3].Two children (2/558,0.4%)
infected subjects expected. However, early data had cyanotic lesions. In the older HIV-infected
raised concerns about HAART being associated with cohort,there was a congenital cardiovascular mal-
an increase in both peripheral and coronary arterial formation prevalence of 7.5% (15/201).The distri-
diseases.HAART is only available to a minority of bution of lesions did not differ significantly
HIV-infected individuals worldwide, and studies between the groups.There was no statistically sig-
prior to HAART therapy remain globally applicable. nificant difference in congenital cardiovascular
As 36.1 million adults and children are estimated to malformation prevalence in the HIV-infected com-
be living with HIV/AIDS and 5.3 million adults and pared to the HIV-uninfected children born to HIV-
children are estimated to have been newly infected infected women. With the use of early screening
with HIV during the year 2000 [2],HIV-associated echocardiography,rates ofcongenital cardiovascu-
symptomatic heart failure may become one of the lar malformations in both the HIV-infected and
leading causes of heart failure worldwide.A variety HIV-uninfected children were five- to tenfold
ofpotential etiologies have been postulated for HIV- higher than rates reported in population-based
related heart disease,including myocardial infection epidemiologic studies,but not higher than in nor-
with HIV itself,opportunistic infections,viral infec- mal populations similarly screened [3].
tions,autoimmune response to viral infection,drug-
related cardiotoxicity, nutritional deficiencies, and
Dilated Cardiomyopathy
prolonged immunosuppression (Table 1).
The estimated annual incidence of dilated car-
Congenital Cardiovascular Malformations in diomyopathy with HIV infection before introduc-
HIV-Infected Children tion of HAART was 15.9 in 1,000 cases [4].Symp-
toms ofheart failure may be masked in HIV-infect-
Most pediatric patients with HIV are infected in ed patients by concomitant illnesses such as diar-
the perinatal period [3].In a prospective,longitu- rhea or malnutrition,or may be disguised by bron-