Lelia Escaut1, Jean Jacques Monsuez1, Gilles Chironi2, Mansouriah Merad1, Elina Teicher1, Denis Smadja1, Alain Simon2, Daniel Vittecoq3. 1. Service des Maladies Infectieuses, Hôpital Paul Brousse, 12-14 avenue Paul Vaillant Couturier, 94804, Villejuif, France. 2. Service des Maladies Cardiovasculaires, Hôpital Broussais, Paris, France. 3. Service des Maladies Infectieuses, Hôpital Paul Brousse, 12-14 avenue Paul Vaillant Couturier, 94804, Villejuif, France. daniel.vittecoq@pbr.ap-hop-paris.fr.
Abstract
OBJECTIVE: To assess the incidence, clinical features, treatment, and follow-up of coronary events in HIV-infected patients over a period of 5 years. PATIENTS AND PARTICIPANTS: A cohort of 840 patients. MEASUREMENTS AND RESULTS: A coronary event occurred in 17 patients (5.9/1000 persons-years). Sixteen of them were exposed to highly active antiretroviral therapy (HAART). Patients with coronary events differed in age (48.3 vs. 43 years), CD4 T-cell count (284 vs. 486/mm(3)), total cholesterol (6.2 vs. 5.3 mmol/l), HDL cholesterol (0.72 vs. 1.16 mmol/l), and LDL cholesterol (4.95 vs. 3.391.61 mmol/l). No difference was observed regarding duration of HAART, weight, glucose level, or smoking status between the two groups. Acute coronary syndrome was the first manifestation in 14 patients. Coronary angiography showed 2.56 stenosis per patient, with a single vessel involvement in one-half. Percutaneous angioplasty was performed in all cases, with stenting in 11. After a mean follow-up of 36 months, 14 patients remain alive. Restenosis ( n=4) occurred in 3 patients (PTCA 3; stenting 4). All 14 patients are free of heart failure symptoms. Their mean left ventricular ejection fraction is 61%. CONCLUSIONS: A higher coronary-event rate is observed among HIV-infected patients, associated with drug-induced metabolic disturbances and a high prevalence of tobacco smoking. However, treatment and prognosis of acute myocardial infarction has no specificity.
OBJECTIVE: To assess the incidence, clinical features, treatment, and follow-up of coronary events in HIV-infectedpatients over a period of 5 years. PATIENTS AND PARTICIPANTS: A cohort of 840 patients. MEASUREMENTS AND RESULTS: A coronary event occurred in 17 patients (5.9/1000 persons-years). Sixteen of them were exposed to highly active antiretroviral therapy (HAART). Patients with coronary events differed in age (48.3 vs. 43 years), CD4 T-cell count (284 vs. 486/mm(3)), total cholesterol (6.2 vs. 5.3 mmol/l), HDL cholesterol (0.72 vs. 1.16 mmol/l), and LDL cholesterol (4.95 vs. 3.391.61 mmol/l). No difference was observed regarding duration of HAART, weight, glucose level, or smoking status between the two groups. Acute coronary syndrome was the first manifestation in 14 patients. Coronary angiography showed 2.56 stenosis per patient, with a single vessel involvement in one-half. Percutaneous angioplasty was performed in all cases, with stenting in 11. After a mean follow-up of 36 months, 14 patients remain alive. Restenosis ( n=4) occurred in 3 patients (PTCA 3; stenting 4). All 14 patients are free of heart failure symptoms. Their mean left ventricular ejection fraction is 61%. CONCLUSIONS: A higher coronary-event rate is observed among HIV-infectedpatients, associated with drug-induced metabolic disturbances and a high prevalence of tobacco smoking. However, treatment and prognosis of acute myocardial infarction has no specificity.
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