In our feature ‘Article Snapshot’ we have recently discussed the study: ‘Contribution of the human immunodeficiency virus/acquired immunodeficiency syndrome epidemic to de novo presentations of heart disease in the Heart of Soweto Study cohort.’ (1) from investigators at the University of Cape Town in Cape Town, South Africa.
In that study 518 of 5328 (9.7%) de novo cases of heart disease were identified as HIV-positive, but only 14 of 581 (2.4%) cases related to of coronary artery disease (CAD) were confirmed HIV-positive. The study was subsequently further discussed in the European Heart Journal in an editorial from investigators from the University of Modena and Reggio Emilia, in Modena, Italy (2).
A group of the same authors have just published a meta-analysis of studies focusing on acute coronary syndromes (ACS) in HIV patients. A total of 11 studies including 2442 patients were identified. Rates of in-hospital death were 8.00% (2.8, 12.5; 95% CI), ascribable to cardiovascular events for 7.90% (2.43, 13.37; 95% CI), with 2.31% (0.60, 4.01; 95% CI) developing cardiogenic shock. At a median follow-up of about 2 years, no deaths were recorded, with an incidence of acute myocardial infarction of 9.42% (2.68, 16.17; 95% CI) and of percutaneous coronary revascularization of 20.18% (9.84, 30.51; 95% CI). Moreover, pooled analysis of the studies reporting incidence of acute myocardial infarction in patients exposed to protease inhibitors showed an overall significant risk of 2.68 (odds ratio 1.89, 3.89; 95% CI).
The authors conclude that HIV infected patients admitted for ACS face a substantial short-term risk of death and a significant long-term risk of coronary revascularization and myocardial infarction, especially if receiving protease inhibitors.
In their editorial the authors point out that ‘given the ongoing improvements in our understanding and treatment of HIV/AIDS, leading to increased life expectancy, greater attention has been paid to the impact of this condition on other body organs and systems.’ and that ‘The heart is now key for the prognosis of HIV/AIDS patients in developed countries.’ (2)
1. Sliwa K, Carrington MJ, Becker A,Thienemann F, Ntsekhe M, Stewart S. Contribution of the human immunodeficiency virus/acquired immunodeficiency syndrome epidemicto de novo presentations of heart disease in the Heart of Soweto Study cohort. Eur Heart J. 2011 Nov 1. [Epub ahead of print]
2. Biondi-Zoccai G, D'Ascenzo F, Modena MG. Novel insights on HIV/AIDS and cardiac disease: shedding light on the HAART of Darkness. Eur Heart J. 2011 Nov 21. [Epub ahead of print] PMID: 22108832
3. D'Ascenzo F, Cerrato E, Biondi-Zoccai G, Moretti C, Omedè P, Sciuto F, Bollati M, Modena MG, Gaita F, Sheiban I. Acute coronary syndromes in human immunodeficiency virus patients: a meta-analysis investigating adverse event rates and the role of antiretroviral therapy. Eur Heart J. 2011 Dec 20. [Epub ahead of print] PMID: 22187508