Coronary Heart Disease in HIV-Infected Patients

Abstract

Currently, there are methods of drug exposure to the infection caused by the human immunodeficiency viruses (HIV), that allow to suppress the active replication of the virus in the patient's body. The era of antiretroviral therapy, which has allowed HIV-infected people to live longer, has begun. This led to an increase in their cardiovascular diseases, which occur at an earlier age and are more severe than in people without HIV. Specific or “nontraditional” risk factors damaging vascular wall occur in HIV patients along with traditional risk factors. These factors include: the negative impact of HIV on endothelium, an imbalance of inflammatory mediators, pathological immune activation, a decrease in the level of CD4 cells, a change in the number and function of platelets. The question of the effect of antiretroviral therapy on the occurrence of atherosclerotic vascular lesions remains debatable. Acute coronary syndrome (ACS) is one of the most frequent and most severe cardiovascular events in HIV-infected patients. The risk of myocardial infarction is highest in patients with a viral load of HIV-1 ribonucleic acid (RNA)≥500 copies/ml and a CD4 cell count of <200/ml. The most common form of ACS in HIV patients is ACS with ST segment elevation. Treatment of ACS in HIV patients has some difficulties: a high frequency of stent thrombosis, the frequent occurrence of thrombocytopenia, drug interactions with antiretroviral therapy. The high risk of developing cardiovascular diseases in HIV patients necessitates the introduction of active measures of primary and secondary prevention, taking into account the specific interaction of all drugs taken by the patient.

HIV infection and cardiovascular pathology

“…Функционирование белка-Tat (трансактиватора транскрипции), который необходим для репликации ВИЧ, способствует развитию воспалительного процесса в стенке сосудов, и, тем самым, повышает риск развития атеросклероза и ССЗ [27,28].…”

“…В липидном профиле ВИЧ-инфицированных пациентов, как правило, отмечается повышение уровней холестерина (ХС) липопротеинов низкой плотности и триглицеридов, на фоне нормального или несколько сниженного уровня общего ХС и ХС липопротеинов высокой плотности [27,44].…”

Diseases of the Cardiovascular System in HIV-infected Patients: Risk Factors and Mechanisms of Progression

“…Большинство заболеваний сердечно-сосудистой системы у ВИЧ-инфицированных сопряжено с низким уровнем иммунитета и высокой вирусной нагрузкой [24]. В то же время пациенты с хорошо контролируемой ВИЧ-инфекцией и низким риском имеют высокую распространенность субклинического атеросклероза сонной артерии, а основными ФР являются возраст и интенсивность воспаления.…”