ACRoginiel

Does not relate to epidemiology

De novo presentation of cardiovascular disease in HIV-infected patients

HIV affects a multitude of organ systems and tissues, and is known to upregulate inflammatory response pathways, particularly in patients who do not have access to combination anti-retroviral therapy (ART) . For example, HIV-infected individuals often have lower protein C levels and elevated levels of markers for endothelial activation. Protein C is a known anti-inflammatory, and anti-coagulant molecule; therefore, low levels may indicate an individual is at greater risk for cardiovascular disease and thrombosis. Similarly, upregulation of endothelial activating factors is associated with increased risk of atherosclerosis and therefore increased risk of cardiovascular disease (CVD), and myocardial infarction (MI). Endocrine disruption is also associated with HIV infection, and may contribute to de novo manifestations of CVD1. Yet studies have also shown that prolonged use of highly active anti-retroviral therapy (HAART) also contributes to increased risk for coronary artery disease and MI ,. Use of combination anti-retroviral therapy, consisting of protease inhibitor drugs such as Indinavir, and nonnucleoside reverse-transcriptase inhibitor (NNRTI) drugs such as Nevirapine may increase lipid levels and LDL cholesterol levels. Overtime, patients taking combination therapy may be at increased risk for developing atherosclerotic plaques, or experiencing an MI or stroke4. For example, researchers calculated a relative rate for MI of 1.16 per year of therapy, indicating a doubled risk of MI per five-year exposure. The risk of HAART-associated CVD is highest in developed countries, since treatment is more widely available, and patients are surviving for longer periods of time. Lengthened survival time is associated with a greater risk for developing co-morbidities such as vascular disease, diabetes, and/or overweight or obesity related syndromes. However, several prevention methods exist to either reduce the incidence of CVD in HIV positive patients, or to improve disease-management. Lifestyle interventions along with pharmaceutical interventions are often preferred, although it depends on the health status of the patient and disease severity. Diet and exercise are two of the most benign interventions, although individuals who have taken HAART for prolonged periods of time may also be placed on lipid-lowering drugs such as statins. In contrast, HIV positive patients in the developing world often experience cardiac abnormalities that are characteristic of non-adherence to ARV therapy, and resulting infectious-disease syndromes. HIV-related cardiovascular disease in the developing world predominantly presents itself in the form of pericardial effusion, Pericarditis, and/or HIV-related cardiomyopathy. HIV in South Africa alone affects more than 5 million people, and most are not able to receive combination therapy or HAART. De novo presentations of CVD in developing countries of sub-Saharan Africa are therefore related either to HIV infection, or to cardiovascular manifestations of opportunistic infections. One of the most common opportunistic infections is tuberculosis, which often results in pericardial effusion among moderate to severe cases. Patients who are not prescribed HAART have high viral loads, and low CD4 counts, effectively increasing susceptibility to co-infection6. Individuals generally recover if combination therapy and appropriate antibiotics are administered. While overall, HIV-related cardiomyopathies represent a low proportion of total cases of heart disease in the developing world, greater understanding is needed on the role of prolonged HAART and the risk of CVD. As access improves in the developing world, and ARV medication is more readily prescribed, public health practionners and clinicians may observe an increase in HIV-related co-morbidities that are reflective of cases in developed nations.

Thus moved here Doc James (talk · contribs · email) 21:35, 15 December 2011 (UTC)