The introduction of highly active antiretroviral therapy (HAART) has significantly improved the clinical outcome of HIV disease with increased survival rates. However, the introduction of HAART has generated a contrast in the cardiac manifestations of AIDS. In developed countries, we observed an approximate 30% reduction in the prevalence of HIV-associated cardiomyopathy, possibly related to a reduction of opportunistic infections and myocarditis. In developing countries, however, where the availability of HAART is limited and the pathogenic impact of nutritional factors is significant, we observed an approximate 32% increase in the prevalence of HIV-associated cardiomyopathy and a related high mortality rate from congestive heart failure. Additionally, some HAART regimens in developed countries, especially those including protease inhibitors, may cause an iatrogenic metabolic syndrome (HIV-lipodystrophy syndrome) that is associated with an increased risk of cardiovascular disease. At the same time, the relapse of some opportunistic infections, with possible myocardial involvement, in HIV-infected patients receiving HAART, in the context of the recently described immune reconstitution inflammatory syndrome, yielded an intriguing and complex profile of this dual aspect of cardiology in AIDS in the HAART era. In this new edition of Cardiovascular Disease in AIDS, new insights coming from basic and clinical research in the field of HIV-associated cardiovascular disease and antiretroviral therapy are reported along with the clinical guidelines for a careful stratification of the cardiovascular risk and cardiovascular monitoring of HIV-infected patients receiving HAART. The authors offer a wide overview of the topic for specialists in cardiology and infectious diseases involved in the clinical management of HIV-infected patients.
Cardiologists, specialists in internal medicine, infectious diseases, virology and immunology
- Acquired immunodeficiency syndrome
- Cardiovascular disease
- Highly active antiretroviral therapy
- Human immunodeficiency virus
Table of contents
Natural History of HIV Infection and Evolution of Antiretroviral Therapy.- Evolution and Pathogenesis of the Involvement of the Cardiovascular System in HIV Infection.- Pathogenesis of Antiretroviral Treatment Associated Metabolic Syndrome.- Pathology of Cardiac Complications in HIV Infection.- Pathology of Peripheral and Coronary Vessels in AIDS Patients.- Echocardiographic Findings in HIV-Infected Patients.- Cardiac MRI in Diagnosis of Myocardial Disease in HIV-Infected Patients.- Coronary Heart Disease in HIV-Infected Patients: Epidemiology.- Coronary Artery Disease in HIV-Infected Patients: Clinical Presentation, Pathophysiology, Prognosis, Prevention and Treatment.- Cerebrovascular Disease in HIV-Infected Patients.- Peripheral Arterial Disease in HIV-Infected Patients: Atherosclerosis and Vasculitic Syndromes.- HIV-Associated Pulmonary Hypertension.- Coagulative Disorders in HIV-Infected Patients.- Cardiovascular Complications in HIV-Infected Children.- Cardiac Surgery and the Human Immunodeficiency Virus.- Cardiological Emergencies in HIV-Infected Patients.- Guidelines for the Prevention of Cardiovascular Risk in HIV-Infected Patients Treated with Antiretroviral Drugs.- Appendindix 1: Cardiovascular Monitoring of HIV-Infected Subjects and Cardiovascular Risk Stratification and Primary Prevention of Cardiovascular Disease in Patients Receiving HAART According to the Pavia Consensus Statement.- Appendinx 2: Interactions Between Antiretrovirals and Drugs Commonly Used to Treat Cardiovascular Diseases According to the Pavia Consensus Statement.- Subject index.