Acquired Immunodeficiency Syndrome

IJCS

Original Article

Is Hypertension a Predictor of Mortality in People Living With HIV/AIDS?

Gustavo Eduardo Fante et al. Pedro Antonio Pagote Dall’Omo Karina Bobato do Valle Arcelio Benetoli … Jean Fernando Sandeski Zuber Camila Marineli Martins Erildo Vicente Muller

Abstract

Background:

Hypertension is a chronic non-communicable disease that increases cardiovascular risk and significantly contributes to mortality. It is one of the most prevalent conditions among people living with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS).

Objectives:

The objective of this study was to investigate hypertension as a predictor of mortality in people living with HIV/AIDS, analyzing the association of prior diagnosis of hypertension with morbidity and mortality in this population.

Methods:

This retrospective cohort study evaluated the medical records of 1207 patients receiving treatment at the Specialized Care Service (SAE) of a city in the state of Paraná over 264 months.

Results:

Among patients diagnosed with HIV/AIDS, 13.1% had hypertension. During the analyzed period, 52 deaths were recorded (4.31%), 30.77% of which occurred among patients with hypertension (p = 0.0002). Lower survival was observed among patients with hypertension (p < 0.0001), and mortality was significantly higher among women with hypertension (p < 0.0001). The hazard ratio (HR) for the general population was 3.1 (95% confidence interval [CI]: 1.7–5.6), with an HR of 1.7 for men (95% CI: 0.7–3.7) and 8.2 for women (95% CI: 3.1–21.6).

Conclusions:

Hypertension was a significant predictor of mortality in people living with HIV/AIDS, with a particularly strong impact among women.

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Original Article

The Use of Two-Dimensional Strain Measured by Speckle Tracking in the Identification of Incipient Ventricular Dysfunction in HIV-Infected Patients on Antiretroviral Therapy, Untreated HIV Patients and Healthy Controls

Ronaldo Campos Rodrigues et al. Katia Martins Lopes de Azevedo Samuel Datum Moscavitch Sergio Setubal Claudio Tinoco Mesquita

Abstract

Background:

Most cardiovascular abnormalities in patients infected with the human immunodeficiency virus (HIV) have been associated with myocardial damage directly caused by the virus. Some cases, however, may be associated with adverse effects from antiretroviral therapy (ART). New ventricular function assessment techniques are capable of detecting early changes in the cardiac function of HIV-infected patients using or not using ART. The usefulness of these techniques has been little employed in these patients.

Objectives:

To investigate the potential influence of antiretroviral therapy (ART) on the occurrence of subclinical left ventricular systolic dysfunction evaluated by myocardial strain rate analysis using two-dimensional speckle tracking echocardiography (2-D Echo) in treated HIV patients compared to untreated patients and healthy individuals.

Methods:

Sixty-eight HIV-infected patients with no cardiovascular symptoms, normal left ventricular (LV) ejection fraction (> 0.55 on 2-D Echo) were divided into three groups: 11 patients not using antiretroviral therapy (NT), 24 using protease inhibitor (PI) and 33 using non-nucleoside reverse transcriptase inhibitor (NNRTI). We also studied 30 normal non-HIV infected individuals (Ctrl). Demographic, clinical, biochemical and anthropometric data were collected. Preliminary transthoracic echocardiography included study of myocardial strain using two-dimensional speckle tracking. We studied strain and strain rate in the seventeen left ventricular (LV) myocardial segments in the longitudinal, circumferential and radial axes. Statistical analysis of the data was done with IBM SPSS – version 20 for Windows. Upon analysis of the data, namely the normality of independent variables in the different groups and the homogeneity of the variances between the groups, Kruskal-Wallis’ non-parametric test was done, followed by Dunn’s multiple comparison tests to test the significance of the differences between the values measured in the study groups. A significance level of 5% was adopted for decision-making on statistical tests.

Results:

The mean age of HIV patients was 40 ± 8.65 years and the mean age of controls was 50 ± 11.6 years (p < 0.001). Median LV global longitudinal strain (GLS) of NT patients (-17.70%), PI patients (-18.27%) and NNRTIs (-18.47%) were significantly lower than that of the Ctrl group (-20.77%; p = 0.001). There was no significant difference in mean SLG between treated patients (PI, NNRTI) and untreated (NT) patients. No significant differences were observed in mean circumferential and radial strain, nor on circumferential and radial strain rates between the NT, PI, NNRTI and Ctrl groups.

Conclusion:

The data suggest that HIV patients present, on myocardial strain measured by speckle tracking, signs of early LV systolic dysfunction that seem to be unrelated to the presence of ART. The prognostic significance of this condition in these patients deserves further studies.

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IJCS

Review Article

Cardiovascular Complications of HIV

Hugo Ribeiro Zanetti et al. Leonardo Roever Alexandre Gonçalves Elmiro Santos Resende

Abstract

With the advent of the antiretroviral therapy (ART), people infected with HIV are experiencing a significant increase in life expectancy. However, as this population ages, the morbidity and mortality due to events not related to HIV infection and/or treatment become increasingly clear. Cardiovascular diseases are among the major causes of death, and, thus, understanding the factors that trigger this situation is necessary. This review article will assess how the intrinsic and extrinsic factors related to HIV, ART and the associated risk factors can aid the epidemiological transition of mortality in this population. Moreover, we will present the studies on the epidemiology and pathogenesis of each clinical condition related to HIV-infected individuals, in addition to introducing the major markers of cardiovascular disease in this population. Finally, we will point the main issues to be addressed by health professionals for an adequate prognosis.

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Editorial

Frequency of Subclinical Atherosclerosis in HIV-infected Brazilians

David Everson Uip

The advances in the treatment of the Human Immunodeficiency Virus (HIV) infection have resulted in a significant reduction in the mortality related to the acquired immunodeficiency syndrome (AIDS). Most patients get infected between the ages of 19 and 39 years, receive medicines from the time of diagnosis onward, with no perspective of interruption. In the follow-up of those patients, chronic non-infectious diseases related to several risk factors, such as age and cardiovascular disease, emerge. Some studies have shown the direct action of the HIV on the vascular endothelium (chronic inflammatory process), in addition to the action of the antiretroviral therapy (ART) on the lipid metabolism.

The incidence of cardiovascular events among HIV-infected patients is low, being, thus, difficult to assess. Subclinical atherosclerosis is associated with an increased risk for events in the general population. It can be detected by use of non-invasive methods, such as carotid ultrasound, aimed at measuring the intimal medial thickness and at assessing the presence of atherosclerotic plaque, in addition to coronary computed tomography to calculate the calcium score. Coronary tomography angiography allows the assessment of the presence, composition and extension of coronary plaques, in addition to detecting stenosis.

[…]

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Artigo Original

Calcium score in the evaluation of atherosclerosis in patients with HIV/Aids

Verônica Soares Monteiro et al. Heloisa Ramos Lacerda Marly Uellendahl Tien Man Chang … Valéria Maria de Albuquerque Josefina Cláudia Zirpoli Ricardo Araes Ximenes Maria de Fátima Militão de Albuquerque Demócrito de Barros Miranda Filho Dário Sobral Filho

BACKGROUND: Antiretroviral therapy has dramatically increased life expectancy in patients with HIV/AIDS although atherosclerosis has been associated with long-standing therapy. OBJECTIVE: To investigate the prevalence of atherosclerosis in patients with AIDS undergoing antiretroviral therapy and the influence of different schemes and duration of treatment. METHODS: HIV/AIDS patients were approached during routine consultations. Those who had been on antiretroviral therapy for at least two years had their blood collected for analysis of lipid profile and fasting glycemia and underwent cardiac CT for quantification of calcium score within six days at the most. Atherosclerosis was defined as calcium score greater than zero (CAC > 0). Traditional risk factors, metabolic syndrome and Framingham score were analyzed. RESULTS: Fifty-three patients performed cardiac CT. Twenty-seven (50.94%) were male, mean age 43.4 years; 20.00% had hypertension, 3.77% diabetes, 67.92% hypercholesterolemia, 37.74% hypertriglyceridemia and 47.17% low HDL. Thirteen (24.53%) met criteria for metabolic syndrome and 96.23% were classified in Framingham score as “low risk.” Ten patients (18.87%) were smokers. Mean duration of antiretroviral treatment was 58.98 months. Coronary atherosclerosis occurred in 11 (20.75%) patients. Duration of antiretroviral therapy was not related to atherosclerosis (p = 0.41) and there were no significant differences between different antiretroviral regimens (p = 0.71). Among traditional risk factors, smoking (OR = 27.20; p = 0.023) and age (OR = 20.59; p = 0.033) were significant in the presence of atherosclerosis. There was a trend towards a positive association of atherosclerosis with hypercholesterolemia (OR = 8.30; p = 0.0668). CONCLUSION: Factors associated with atherosclerosis were age, smoking and hypercholesterolemia. Duration and type of antiretroviral therapy had no influence on the prevalence of atherosclerosis.

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Artigo Original

AIDS in childhood: cardiac involvement with and without triple combination antiretroviral therapy

Maria do Carmo Soares Alves Cunha et al. Aristarco Gonçalves de Siqueira Filho Silvia Reis dos Santos Thalita Fernandes de Abreu … Ricardo Hugo S. de Oliveira Denise Marcelino Baptista Marylane Christian Feitosa Dantas Márcia Fernanda Carvalho Luciane Gaspar Guedes

OBJECTIVE: To describe the prevalence of cardiac abnormalities in the echocardiogram of children with AIDS followed up in a reference service at 18±6 months of AIDS confirmed diagnosis. METHODS: A cross-section study with a cohort after 18±6 months of AIDS diagnosis. The study included a total of 93 children with a confirmed diagnosis of AIDS with vertical transmission, with no malignancies and who underwent echocardiogram (echo) during cardiologic evaluation. Cardiac abnormalities were assessed in patients who were not treated (G1) and patients who were treated (G2) with combination antiretroviral therapy. RESULTS: When diagnosed with AIDS, the children were on average 3.07 years old and 50.50% were female. The combination regimen with antiretroviral agents was used by 47 patients (G2). Cardiac involvement was present in 40 children (43.00%). The presence of left ventricular dysfunction (G1: 39.10%; G2: 10.60%) and the isolated enlargement of left ventricle (G1: 6.60%; G2: 14.90%) were the most frequent findings. We observed a significant association between the groups without and with combination antiretroviral therapy asregards the presence of left ventricular dysfunction (PR= 3.42; [1.41-8.26]; p = 0.02) and malnutrition (PR = 1.79; [1.00-3.20]; p = 0.04). CONCLUSION: Cardiac involvement was frequent in children with AIDS and left ventricular dysfunction was the most common abnormality on echocardiogram. There was a statistically significant difference between the groups with and without triple combination treatment as regards the presence of left ventricular dysfunction and malnutrition.

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