ABSTRACT
Highly active antiretroviral therapy (HAART) significantly changed the prevalence of the cardiovascular manifestations of human immunodeficiency virus (HIV)/AIDS. In developed countries, a 30 per cent reduction in the prevalence of cardiomyopathy and pericardial effusion was observed, possibly related to a reduction of opportunistic infections and myocarditis. In developing countries, however, where the availablity of HAART is limited, and the pathogenic impact of nutritional factors is significant, a 32 per cent increase was seen in the prevalence of cardiomyopathy and related high mortality rate from congestive heart failure. Also, some HAART regimens in developed countries, especially those including protease inhibitors, may cause, in a high proportion of HIV-infected patients, a lipodystrophy syndrome that is associated with an increased risk of cardiovascular events related to a process of accelerated atherosclerosis. Careful cardiac screening is warranted for patients who are being evaluated for, or who are receiving HAART regimens, particularly for those with known underlying cardiovascular risk factors, according to the most recent clinical guidelines.
ABSTRACT
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 percent 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 increase of approximately 32 percent in the prevalence of HIV-associated cardiomyopathy and a related high mortality rate from congestive heart failure. Also, some HAART regimens in developed countries, especially those including protease inhibitors, have been shown to cause, in a high proportion of HIV-infected patients, a iatrogenic metabolic syndrome (HIV-lipodystrophy syndrome).This is associated with an increased risk of atherosclerosis-related cardiovascular events even in young HIV-infected people. A better understanding of the molecular mechanisms responsible for this syndrome will lead to the discovery of new drugs that will reduce cardiovascular risk in HIV-infected patients receiving HAART.
A introdução da terapia antitroviral altamente potente (HAART) melhorou significativamente a evolução clínica da infecção pelo HIV com um aumento nas taxas de sobrevida. Apesar deste benefício, o uso da HAART gerou contrastes nas manifestações cardíacas da Aids. Nos países desenvolvidos, observou-se uma redução de aproximadamente 30 por cento na prevalência de cardiomiopatia associada ao HIV, possivelmente relacionada à redução das infecções oportunistas e da miocardite. Nos países em desenvolvimento, entretanto, aonde a disponibilidade da HAART é limitada e o impacto patogênico dos fatores nutricionais é significante, observou-se um aumento de 32 por cento na prevalência de cardiomiopatia e uma alta taxa de mortalidade relacionada com a insuficiência cardíaca congestiva. Além disso, alguns tipos de HAART nos países desenvolvidos, especialmente aqueles que incluem inibidores da protease, têm causado em uma alta proporção de pacientes, uma síndrome metabólica iatrogênica (síndrome da lipodistrofia relacionada ao HIV) que está associada ao aumento do risco de eventos cardiovasculares relacionados à aterosclerose mesmo em indivíduos jovens infectados pelo HIV. Uma melhor compreensão dos mecanismos moleculares responsáveis por esta síndrome levará ao descobrimento de novas drogas que irão reduzir o risco cardiovascular em pacientes infectados pelo HIV que recebem HAART. [Rev Assoc Med Bras 2009; 55(5): 621-30]