CV
Cardiovascular Manifestations of HIV
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Cardiovascular Manifestations of HIV
, HIV related Cardiovascular Complications, HIV Cardiomyopathy
See Also
HIV Complications
Causes
Infection
Mycobacterium
Nocardia
Cryptococcus neoformans
Histoplasma capsulatum
Aspergillus
Cytomegalovirus
(CMV)
Epstein-Barr Virus
(EBV)
Toxoplasmosis
Causes
Medication adverse effects
Direct cardiotoxicity
Abacavir
(
Ziagen
)
Lopinavir/Ritonavir
(
Kaletra
)
Dyslipidemia or
Lipodystrophy
Protease Inhibitor
s (especially boosted
Protease Inhibitor
s)
Abacavir
Efavirenz
Elvitegravir/
Cobicistat
Findings
Common
Coronary Artery Disease
Longstanding HIV carries a coronary disease equivalent risk similar to
Diabetes Mellitus
CD4 Count
<500 is associated with an increased risk of coronary events (even if it rebounds)
Patients with HIV also have higher rates of
Tobacco Abuse
and
Hypertension
Frieberg (2013) JAMA Intern Med 173(8):614-22 [PubMed]
Cerebrovascular Disease
Secondary to direct HIV neurotoxicity, opportunistic infections,
Coagulopathy
, chronic inflammation
Patients with HIV also have higher rates of
Tobacco Abuse
,
IVDA
, CAD,
Hypertension
, CKD
Strokes occur at younger ages in HIV patients (esp. with lower
CD4 Count
s, higher viral loads)
D'Ascenzo (2015) J Cardiovasc Med 16(12):839-43 [PubMed]
Dyslipidemia
Obtain lipid panel and
Serum Glucose
at time of HIV diagnosis
Repeat lipid panel and
Glucose
screening at perioidic intervals
Consider
Statin
s if indicated (based on non-
HIV Infection
guidelines)
Risk of
Statin
-related
Drug Interaction
s with
Protease Inhibitor
s,
NNRTI
agents
Dilated Cardiomyopathy
(25% advanced HIV)
Left Ventricular Dysfunction
(21% advanced HIV)
Myocardial fibrosis
Present in up to 82% of HIV patients and often asymptomatic
Less common
Myocarditis
Pericardial Effusion
Pericarditis
Arrhythmia
s
Rare Conditions
Endocarditis
Symptoms
Most are asymptomatic
Signs
Usually clinically silent
Pericardial Effusion
s (usually sterile) in 25%
Management
See
Cardiomyopathy
In those with
Cardiac Risk Factor
s, avoid agents with cardiotoxicity risk (see above)
Tobacco Cessation
Hyperlipidemia Management
wth
Statin
indicated for 10 year
Cardiac Risk
>5 to 7.5%
Risk of
Statin-Induced Myopathy
Start with low dose
Atorvastatin
(
Lipitor
) 10 mg or
Rosuvastatin
(
Crestor
)
Reference
(2019) Presc Lett 26(8): 46
Mathieu (
Apri
l, 2000) Federal Practitioner, p. 18-20
Swaminathan and Bafuma in Herbert (2017) EM:Rap 17(3): 2
Chu (2017) Am Fam Physician 96(3): 161-9 [PubMed]
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