RESUMO
BACKGROUND: There have been several reports describing PAH and cor pulmonary in HIV infected patients like observed in patients with primary PAH. PATIENTS AND METHODS: We retrospectively studied 14 patients with HIV infection and PH documented by Doppler echocardiography diagnosed during the last 9 years (1991-1999). RESULTS: The mean length of time from the onset of symptoms to the diagnosis was 4 months (r: 1 week-1 year). PAH was diagnosed as mild in 3 cases (23%), moderate in 7 (54%) and severe in 4 and the mean value of right ventricular systolic pressure was 57.96 mmHg. Ten patients were conventionally treated and in 5 cases progressive right sided heart failure was developed. In this group, carvedilol was prescribed with a favourable evolution in four of them. Three cases did not required treatment. All the patients were followed for 2 years (r: 1-8) and three deaths happened (22%). CONCLUSIONS: The grade of PH in patients with HIV is moderate-severe, the time between onset of symptoms and diagnosis is very long but survival is not poor. Carvedilol could be an alternative therapy in patients who dose responses to another treatments and with progressive right heart failure.
Assuntos
Infecções por HIV/complicações , Hipertensão Pulmonar/etiologia , Adulto , Anti-Hipertensivos/administração & dosagem , Anti-Hipertensivos/uso terapêutico , Carbazóis/administração & dosagem , Carbazóis/uso terapêutico , Carvedilol , Ecocardiografia Doppler , Feminino , Seguimentos , Humanos , Hipertensão Pulmonar/diagnóstico , Hipertensão Pulmonar/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Propanolaminas/administração & dosagem , Propanolaminas/uso terapêutico , Doença Cardiopulmonar/diagnóstico , Doença Cardiopulmonar/etiologia , Estudos Retrospectivos , Fatores de TempoRESUMO
BACKGROUND: Left-sided endocarditis in HIV-infected patients has an special clinical, epidemiological and microbiological characteristics and its relationship with drug addicts subjects is unknown. PATIENTS AND METHODS: Since 1986 up to 1996 we have been diagnosed 214 episodes of infective endocarditis in 190 HIV-infected patients. In 34 cases (15%) there was left-sided endocarditis. These patients are described. RESULTS: Mean age was 30 years and 28 were male (82%). Thirty patients had been intravenous drug addicts (IVDA) but only 18 were active-IVDA. In three cases the endocarditis was nosocomial. Mean CD4+ lymphocyte count was 176 per mm3 and 59% were AIDS-patients. Tuberculosis was the most frequent opportunistic infection (14 cases). The presentation was subacute in 70% and the most important symptom was fever. Only 3 (9%) had septic emboli in chest X-ray. The affected valve was mitral in 31 patients (91%). The blood culture was negative in 21 episodes (62%) and only in 6, Staphylococcus aureus was isolated. The mortality was 18% and 68% were outcome without any problem. CONCLUSIONS: Left-sided endocarditis in patients with HIV infection is a very serious problem. It seems to affect to patients with severe immunosuppression and the culture blood may be negative. Its diagnosis is difficult and the mortality is elevated.
Assuntos
Endocardite Bacteriana/etiologia , Infecções por HIV/complicações , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Doença Aguda , Adulto , Interpretação Estatística de Dados , Ecocardiografia , Endocardite Bacteriana/diagnóstico , Feminino , Humanos , Masculino , Valva Mitral , Radiografia Torácica , Abuso de Substâncias por Via Intravenosa/complicações , Valva Tricúspide , Tuberculose/diagnósticoRESUMO
Fundamento: La endocarditis de localización izquierda en los pacientes VIH+ tiene unas especiales caracteristicas clinicas, epidemiológicas y microbiológicas y es desconocida su relación con la drogadicción. Pacientes y métodos: Entre 1986 y 1996 se diagnosticaron 214 episodios de endocarditis infecciosa en 190 pacientes VIH+. En 34 casos (15%) existió endocarditis de válvulas izquierdas (EVI). Se describen sus hallazgos clínicos, inmunológicos, epidemiológicos y evolutivos. Resultados: La edad media fue 30 años y 28 (82%) eran varones. 30 habían sido drogadictos (88%) y 18 continuaban con consumo activo. En 3 casos, la EVI fue nosocomial. La media de linfocitos CD4+ fue de 176 por mm3 y el 59 porciento cumplían criterios de sida. La infección oportunista diagnosticada con mayor frecuencia fue la tuberculosis (14 casos). La evolución fue subaguda en el 70 porciento y la fiebre la manifestación clínica fundamental. Sólo 3 (9%) presentaron émbolos sépticos en la radiografía de tórax. La localización más frecuente fue la mitral (31 pacientes, 91 porciento). En 21 episodios (62 %) los hemocultivos fueron negativos y sólo en 6 (18%) el responsable fue el Staphylococcus aureus. La mortalidad fue del 18% y el 68 porciento curaron sin secuelas. Conclusiones: La EVI en los pacientes con infección por VIH aparece de forma subaguda, en los gravemente inmunodeprimidos y con frecuencia los hemocultivos son negativos. Tiene una elevada mortalidad y su diagnóstico es difícil (AU)
