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Summary of HIV-Associated Cardiovascular Diseases

Penyakit Jantung yang Berhubungan dengan HIV

Disease Type Possible Causes Incidence/Prevalence Diagnosis Treatment
Dilated cardiomyopathy
Drug-related: cocaine, AZT, IL-2, doxorubicin, interferon
Infectious: HIV, Toxoplasma, coxsackievirus group B, EBV, CMV, adenovirus
Metabolic or endocrine: selenium or carnitine deficiency, anemia, hypo-calcemia, hypophos-phatemia, hyponatremia, hypokalemia, hypo-albuminemia, hypo-thyroidism, growth hormone deficiency, adrenal insufficiency, hyper-insulinemia, hemochromatosis, pheochromocytoma, sarcoidosis, amyloidosis
Cytokines: TNF-α, nitric oxide, TGF-β, endothelin-I, interleukins
Immunodeficiency: CD4 < 100 cells/mm3

Up to 8% of asymptomatic patients
Up to 25% of autopsy cases
Systolic > diastolic

Chest radiographic findings: non-specific conduction abnormalities, PVCs, PACs
Echocardiographic findings: low-normal LV wall thickness, increased LV mass, dilated LV, systolic LV dysfunction
Possible laboratory studies: troponin T, brain natriuretic peptide level, CD4 count, viral load, viral PCR, Toxoplasma serology, thyroid-stimulating hormone, cortisol, carnitine, selenium, serum ACE, vanillylmandelic acid, amyloid, urine analysis, stress testing, myocardial biopsy, cardiac catheterization

Diuretics, digoxin, ACE inhibitors, beta blockers
Adjunctive treatment in HIV patients: treatment of infection; nutritional replacement; IVIG; intensify antiretroviral therapy
Follow-up: serial echocardiography
Bacteria: Staphylococcus, Streptococcus, Proteus, Klebsiella, Enterococcus, Listeria, Nocardia, Mycobacterium
Viral pathogens: HIV, HSV, CMV, adenovirus, echovirus
Other pathogens: Cryptococcus, Toxoplasma, Histoplasma
Malignancy: Kaposi sarcoma, lymphoma, capillary leak, wasting, malnutrition
11%/year, spontaneous resolution in 42% of affected patients; ∼ 30% increase in 6-month mortality
Pericardial rub on examination
Fluid analysis for Gram stain and culture, cytology
ECG: low voltage, PR depression
Associated pleural and peritoneal fluid analysis
Pericardial biopsy
Treat the cause Follow-up: serial echocardiography; intensify antiretroviral therapy; pericardiocentesis or window
Infective endocarditis
Bacteria: Staphylococcus aureus or S. epidermidis, Salmonella, Streptococcus, Haemophilus para-influenzae, Pseudallescheria boydii, HACEK
Fungal: Aspergillus fumigatus, Candida, Cryptococcus neoformans
6% increased incidence in IVDA, regardless of HIV status Blood cultures; echocardiography IV antibiotics, valve replacements
Nonbacterial thrombotic endocarditis Valvular damage, vitamin C deficiency, malnutrition, wasting, DIC, hypercoagulable state, prolonged acquired immunodeficiency Rare but clinically relevant emboli in 42% of cases Echocardiography Anticoagulation, treat vasculitis or underlying illness
Malignancy Kaposi sarcoma, non–Hodgkin lymphoma, leiomyosarcoma, low CD4 count, prolonged immunodeficiency, HHV-8, EBV Approximately 1% incidence, usually metastatic in HIV-positive patients Echocardiography, biopsy Chemotherapy possible
Right ventricular and pulmonary disease Recurrent pulmonary infections, pulmonary arteritis, microvascular pulmonary emboli ECG, echocardiog-raphy, right heart catheterization Diuretics, treat underlying lung infection or disease, anticoagulation
Primary pulmonary hypertension Plexogenic pulmonary arteriopathy 0.5% ECG, echocardiog-raphy, right heart catheterization Anticoagulation, vasodilators, prostacyclin analogues
Vasculitis Drug therapy with antibiotics and antivirals Increasing incidence Clinical diagnosis Systemic corticosteroids, withdrawal of drug
Accelerated atherosclerosis Protease inhibitors, atherogenesis with virus-infected macrophages, chronic inflammation, glucose intolerance, dyslipidemia Up to 8% prevalence Stress testing, echocardiography, lipid profile, CT angiography, calcium scoring Minimize risk factors
Autonomic dysfunction CNS disease, drug therapy, prolonged immunodeficiency, malnutrition Increased in patients with CNS disease Tilt-table test, Holter monitoring Procedural precautions
Arrhythmias Drug therapy, pentamidine, autonomic dysfunction, acidosis, electrolyte abnormalities ECG: long QT, Holter monitoring, exercise stress testing Discontinue drug, procedural precautions
Lipodystrophy Drug therapy: protease inhibitors Echocardiography, lipid profile, cardiac catheterization, coronary calcium score Lipid therapy (beware of drug interactions), aerobic exercise, altered antiretroviral therapy, cosmetic surgery, fat implantation
ACE = angiotensin-converting enzyme; AZT = azidothymidine; CMV = cytomegalovirus; CNS = central nervous system; DIC = disseminated intravascular coagulation; EBV = Epstein-Barr virus; ECG = electrocardiogram; HHV = human herpesvirus; HIV = human immunodeficiency virus; HSV = herpes simplex virus; HTN = hypertension; IL-2 = interleukin-2; IVDA = intravenous drug abuse; IVIG = intravenous immunoglobulin; LV = left ventricular; PAC = premature atrial complex; PCR = polymerase chain reaction; PVC = premature ventricular complex; TGF = transforming growth factor; TNF = tumor necrosis factor.

Braunwald's Heart Disease 8E (Saunders) 2007

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