Étude de la prévalence des cardiomyopathies au cours de l’infection VIH : étude prospective de 158 patients VIH

Hattaoui, Mustapha El; Charei, N.; Boumzebra, Drissi; Aajly, Lahcen; Fadouach, S.

doi:10.1016/j.medmal.2008.03.006

Cited by 13 publications

(9 citation statements)

References 23 publications

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“…Recent clinical studies in countries lacking universal access to HAART have provided some insights into the relative importance of HIV infection against its pharmacotherapy in HIV cardiomyopathy. These recent studies appear to consistently find that HIV cardiomyopathy is far more prevalent among patients with HIV alone against those with HIV who also received HAART [25][26][27][28][29]. Thus, HIV infection appears to contribute more to HIV cardiomyopathy than does its treatment.…”

Section: Discussionmentioning

confidence: 91%

“…Potential mechanisms responsible include both indirect (e.g., cytokines, co-infection, nutritional deficiencies, and drugs) and direct effects of HIV proteins (e.g., gp120 and tat) [7][8][9][10][11]. The advent of HAART (Highly Active Anti Retroviral Therapies) has prolonged survival, but has been considered a potential source of cardiovascular complications of HIV infection [25][26][27][28][29]. Recent clinical studies in countries lacking universal access to HAART have provided some insights into the relative importance of HIV infection against its pharmacotherapy in HIV cardiomyopathy.…”

Section: Discussionmentioning

confidence: 99%

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Dilated Cardiomyopathy in Transgenic Mice Expressing HIV Tat

et al. 2009

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Mechanisms responsible for HIV cardiomyopathy are unknown, but may include direct effects of HIV proteins on the heart. Transgenic mice (TG) expressing HIV Tat protein targeted to the myocardium, +/- Tat TG, have revealed anatomical and biochemical defects in the heart. The present studies were conducted to clarify the effect of Tat on cardiac function. In vivo hemodynamics was measured in awake mice after inserting a catheter tip in the left ventricle under general anesthesia. Under the age of 3 months, the heart rate (HR) was significantly lower in TG (591 +/- 47 vs. 716 +/- 45 bpm, TG versus FVB control (FVB), respectively (P < 0.05; n = 8-12). Other hemodynamic indexes, including left ventricular systolic pressure (LVSP), positive and negative dp/dt (mmHg/s), and left ventricular end diastolic pressure (LVEDP) remained indistinguishable from FVB. At 6 months, however, ventricular dysfunction was evident in TG (HR = 580 +/- 47 vs. 673 +/- 25 bpm, TG versus FVB, P < 0.05); LVSP (132 +/- 6 vs. 147 +/- 6 mmHg, TG versus FVB; P < 0.05); LVEDP (15 +/- 4 vs. 8 +/- 6 mmHg, TG vs. FVB, P < 0.05); +dp/dt = 8872 +/- 331 vs. 10026 +/- 796 mmHg/s TG versus FVB, P < 0.01) and -dp/dt (7403 +/- 432 vs. 8835 +/- 368 mmHg/s, TG versus FVB, P < 0.01; n = 8-12, in each group). The change in percentage of fractional shortening in response to isoproterenol was also significantly reduced in cardiac myocytes isolated from TG versus FVB (P < 0.05). Thus, targeted myocardial transgenic expression of HIV Tat in mice results in relative bradycardia, depression in systolic and diastolic functions in vivo, and blunted adrenergic responsiveness in vitro.

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Dilated Cardiomyopathy in Transgenic Mice Expressing HIV Tat

et al. 2009

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“…The cause of HIV cardiomyopathy is complex and includes myocarditis due to HIV itself or opportunistic pathogens, autoimmune processes, nutritional deficiencies (i.e., selenium) and cardio-toxicity due to antiretroviral agents (15). The development of dilated cardiomyopathy in patients with HIV is strongly associated with advanced stages of the disease (e.g., low CD4 count) (4,16). The introduction of HAART has significantly reduced the prevalence of HIV cardiomyopathy in developed countries.…”

Section: Discussionmentioning

confidence: 99%

Inotropic Contractile Reserve Can Risk-Stratify Patients With HIV Cardiomyopathy

Wever-Pinzon

Bangalore

Romero

et al. 2011

JACC: Cardiovascular Imaging

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OBJECTIVES The purpose of this study was to assess whether inotropic contractile reserve (ICR) during dobutamine stress echocardiography (DSE) could risk-stratify patients with human immunodeficiency virus (HIV) cardiomyopathy and predict improvement of left ventricular ejection fraction (LVEF). BACKGROUND HIV cardiomyopathy is an important cause of heart failure and death. ICR is associated with better survival and improvement of LVEF in patients with ischemic and nonischemic cardiomyopathies. However, the prognostic value of ICR in patients with HIV cardiomyopathy is unknown. METHODS Patients with HIV cardiomyopathy and a LVEF <45% who were referred for DSE were enrolled. ICR was evaluated by the delta wall motion score index (ΔWMSI), calculated as the difference between rest and peak WMSI. Patients were followed for cardiac death and change in LVEF on follow-up. RESULTS Sixty patients (75% men; age, 54 ± 9 years) with HIV cardiomyopathy (mean LVEF, 28 ± 11%) formed the study group. After 2.4 ± 2.1 years, 11 cardiac deaths occurred (event rate of 7.6%/year). A receiver-operating characteristic curve identified a ΔWMSI of 0.38 as an optimal cut point for the presence of ICR, with a specificity of 88% and a sensitivity of 73% for the prediction of cardiac death. On univariable analysis, the absence of ICR (hazard ratio: 6.6; 95% confidence interval: 1.93 to 22.62; p = 0.003) and New York Heart Association functional class IV (hazard ratio: 7.2; 95% confidence interval: 2.20 to 23.65; p = 0.001) were the only predictors of cardiac death. After 2.1 ± 1.8 years, 41 patients had a follow-up echocardiogram. LVEF improvement from baseline occurred in 23 patients (56%), more so in patients with ICR than without ICR. A ΔWMSI of 0.59 predicted improvement in the LVEF with a specificity of 78% and a sensitivity of 74%. CONCLUSIONS The presence of ICR during DSE can risk-stratify and predict subsequent improvement in LVEF in patients with HIV cardiomyopathy.

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“…A systematic review and meta-analysis investigating LVSD in paucisymptomatic HIV-infected patients in the ART era found that active tobacco smoking was associated with a 1.57-fold higher odds of having HF and was second only to age as the univariate risk factor for HF (41). Only 1 of the included studies, however, was from an LMIC (42). A study from Rwanda has shown that the relationship among alcohol intake, cigarette smoking, and dilated cardiomyopathy in PLHIV is attenuated after adjusting for HIV stage, socioeconomic status, duration of HIV infection, and plasma selenium levels (43).…”

Section: Causes Of Hiv-associated Hfmentioning

confidence: 99%

“…PLHIV usually have HF diagnosed in the third decade of life and are more often women. Both systolic and diastolic dysfunctions are more common (∼30% prevalence) in PLHIV than in controls without HIV (65), and rarely, diastolic dysfunction is more prevalent (42,60). Ventricular dimensions and mass are large in PLHIV with HF in SSA, similar to findings from North America (65,76).…”

Section: Epidemiology Of Hiv-associated Hf In Lmics In the Art Eramentioning

confidence: 99%

Human Immunodeficiency Virus and Heart Failure in Low- and Middle-Income Countries

Bloomfield

Alenezi

Barasa

et al. 2015

JACC: Heart Failure

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Successful combination therapy for human immunodeficiency virus (HIV) has transformed this disease from a short-lived infection with high mortality to a chronic disease associated with increasing life expectancy. This is true for high- as well as low- and middle-income countries. As a result of this increased life expectancy, people living with HIV are now at risk of developing other chronic diseases associated with aging. Heart failure has been common among people living with HIV in the eras of pre- and post- availability of antiretroviral therapy; however, our current understanding of the pathogenesis and approaches to management have not been systematically addressed. HIV may cause heart failure through direct (e.g., viral replication, mitochondrial dysfunction, cardiac autoimmunity, autonomic dysfunction) and indirect (e.g., opportunistic infections, antiretroviral therapy, alcohol abuse, micronutrient deficiency, tobacco use) pathways. In low- and middle-income countries, 2 large observational studies have recently reported clinical characteristics and outcomes in these patients. HIV-associated heart failure remains a common cardiac diagnosis in people living with heart failure, yet a unifying set of diagnostic criteria is lacking. Treatment patterns for heart failure fall short of society guidelines. Although there may be promise in cardiac glycosides for treating heart failure in people living with HIV, clinical studies are needed to validate in vitro findings. Owing to the burden of HIV in low- and middle-income countries and the concurrent rise of traditional cardiovascular risk factors, strategic and concerted efforts in this area are likely to impact the care of people living with HIV around the globe.

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Étude de la prévalence des cardiomyopathies au cours de l’infection VIH : étude prospective de 158 patients VIH

Cited by 13 publications

References 23 publications

Dilated Cardiomyopathy in Transgenic Mice Expressing HIV Tat

Dilated Cardiomyopathy in Transgenic Mice Expressing HIV Tat

Inotropic Contractile Reserve Can Risk-Stratify Patients With HIV Cardiomyopathy

Human Immunodeficiency Virus and Heart Failure in Low- and Middle-Income Countries

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