Editorial

Reversible Right Ventricular Dysfunction In HIV-infected Patients

Authors: Giuseppe Barbaro, MD

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% reduction in the prevalence of HIV-associated cardiomyopathy, possibly related to a reduction of opportunistic infections and myocarditis.1 In developing countries, however, where the availablity of HAART is limited and the pathogenic impact of nutritional factors is significant, we observed an approximate 32% increase 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, may cause iatrogenic metabolic syndrome (HIV-lipodystrophy syndrome) that is associated with an increased risk of cardiovascular disease with an estimated incidence of 1.4 cardiac events per 1,000 years of therapy according to the Framingham score.1

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References

1. Barbaro G. Reviewing the cardiovascular complications of HIV infection after the introduction of highly active antiretroviral therapy. Curr Drug Targets Cardiovasc Haematol Disord 2005;5:337–343.
 
2. Rangasetty UC, Rahman AM, Hussain N. Reversible right ventricular dysfunction in patients with HIV infection. South Med J 2006;99: 274–278.
 
3. Shahmanesh M, Bradbeer CS, Edwards A, et al. Autonomic dysfunction in patients with human immunodeficiency virus infection. Int J STD AIDS 1991;2:419–423.
 
4. Barbaro G. HIV-associated cardiomyopathy: etiopathogenesis and clinical aspects. Herz2005;30:486–492.
 
5. Barbaro G, Lucchini A, Barbarini G. Highly active antiretroviral therapy in naive patients with HIV-associated pulmonary hypertension. HIV AIDS Rev 2004;3:5–7.
 
6. Volberding PA, Murphy RL, Barbaro G. et al. The Pavia Consensus Statement. AIDS 2003;17 S170–S179.