Cardiac diseases in AIDS medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Raviteja Guddeti, M.B.B.S. [2]
Medical Therapy
Pericarditis
Majority of the AIDS patients with pericarditis are asymptomatic. Small pericardial effusions without tamponade can be followed up without any further testing. In symptomatic patients with large effusions with or without a tamponade, pericardiocentesis is indicated to obtain culture and cytology [1]. If tamponade occurs, immediate drainage is necessary [2].
It is recommended that patients with pericarditis of unknown etiology be treated emperically for Mycobacterium tuberculosis (4-drug therapy (isoniazid, rifampicin, pyrazinamide, and ethambutol) for 2 months followed by 2 drugs (isoniazid and rifampicin) for 4 months). Addition of prednisolone to anti-tubercular therapy is associated with rapid recovery, lower mortality rates and decreased need for surgical intervention [3][4].
Bacterial and fungal causes of pericarditis are treated with appropriate anti-bacterials and anti-fungals.
Pericarditis secondary to lymphoma can be treated with radiation and/or chemotherapy. However, combination chemotherapy has been shown to significantly increase the risk of early death from opportunistic infections.
Heart Failure
Treatment of heart failure in patients with AIDS is similar to that of in general population. ACE inhibitors, diuretics, beta-blockers and digoxin are indicated as usual. Also, drugs that are known to cause cardiac side effects should be discontinued.
Lifestyle modification (smoking cessation, weight reduction) and control of hypertension, diabetes and elevated cholesterol should be paid special attention.
Infective Endocarditis
Treatment of infective endocarditis in HIV-infected patients is similar to that of in the general population. Appropriate antibiotics against methicillin resistant Staphylococcus aureus (MRSA) should be administered for those who are IV drug abusers.
Cardiac Tumors
Chemotherapy and radiation therapy have been shown to have a variable effect in the treatment of primary cardiac lymphoma [5].
Management of Coronary Risk Factors in HIV-Infected Patients
In HIV patients with cardiovascular risk factors risk assessment is done using Framingham risk score [6]. This risk score is used to calculate the 10-year risk of myocardial infarction or cardiac death in HIV patients with two or more risk factors.
Guidelines for the management of dyslipidemia in HIV patients are [7]:
- If triglyceride (TG) levels are between 200 and 500 mg/dL and non-HDL-C cholesterol levels are high a statin is recommended.
- If TG levels are higher than 500 mg/dL a fibrate should be started.
However, statins and fibrates must be used with caution in HIV patients who are on HAART regimens containing protease inhibitors because of possible potential interactions. Protease inhibitors inhibit cytochrome P3A4 that metabolizes statins, thereby elevating the blood levels of these drugs.
References
- ↑ Hsia J, Ross AM (1994). "Pericardial effusion and pericardiocentesis in human immunodeficiency virus infection". The American Journal of Cardiology. 74 (1): 94–6. PMID 8017317. Unknown parameter
|month=ignored (help) - ↑ Chen Y, Brennessel D, Walters J, Johnson M, Rosner F, Raza M (1999). "Human immunodeficiency virus-associated pericardial effusion: report of 40 cases and review of the literature". American Heart Journal. 137 (3): 516–21. PMID 10047635. Unknown parameter
|month=ignored (help) - ↑ Syed FF, Mayosi BM (2007). "A modern approach to tuberculous pericarditis". Progress in Cardiovascular Diseases. 50 (3): 218–36. doi:10.1016/j.pcad.2007.03.002. PMID 17976506.
- ↑ Sunderam G, McDonald RJ, Maniatis T, Oleske J, Kapila R, Reichman LB (1986). "Tuberculosis as a manifestation of the acquired immunodeficiency syndrome (AIDS)". JAMA : the Journal of the American Medical Association. 256 (3): 362–6. PMID 3723722. Unknown parameter
|month=ignored (help) - ↑ Montalbetti L, Della Volpe A, Airaghi ML, Landoni C, Brambilla-Pisoni G, Pozzi S (1999). "Primary cardiac lymphoma. A case report and review". Minerva Cardioangiologica. 47 (5): 175–82. PMID 10479855. Unknown parameter
|month=ignored (help) - ↑ Law MG, Friis-Møller N, El-Sadr WM; et al. (2006). "The use of the Framingham equation to predict myocardial infarctions in HIV-infected patients: comparison with observed events in the D:A:D Study". HIV Medicine. 7 (4): 218–30. doi:10.1111/j.1468-1293.2006.00362.x. PMID 16630034. Unknown parameter
|month=ignored (help) - ↑ Guidelines for the Evaluation and Management of Dyslipidemia in Human Immunodeficiency Virus (HIV)-Infected Adults Receiving Antiretroviral Therapy: Recommendations of the HIV Medicine Association of the Infectious Disease Society of America and the Adult AIDS Clinical Trials Group