Abstract
The clinical status of HIV infection has changed dramatically with the introduction
of combined antiretroviral therapy. Patients with HIV are now living long enough to
be susceptible to chronic illnesses, such as coronary disease and nonischemic cardiomyopathy,
which can be consequences of the combined antiretroviral therapy treatment itself.
Cardiovascular diseases are a major source of morbidity and mortality in HIV-positive
patients. Increasingly, such patients might be candidates for the full range of cardiac
surgical interventions, including coronary bypass, valve surgery, and heart transplantation.
There has been a shift from offering palliative procedures such as pericardial window
and balloon valvuloplasty, to more conventional and durable surgical therapies in
HIV-positive patients. We herein provide an overview of the contemporary outcomes
of cardiac surgery in this complex and unique patient population. We review some of
the ethical issues around the selection and surgical care of HIV-positive patients.
We also discuss strategies to best protect the surgical treatment team from the risks
of HIV transmission. Finally, we highlight the need for involvement of dedicated infectious
disease professionals in a multidisciplinary heart team approach, aiming at the comprehensive
care of these unique and complex patients.
Résumé
Le statut clinique de l’infection par le VIH a évolué de façon spectaculaire avec
l’avènement du traitement antirétroviral combiné. Les patients infectés par le VIH
ont à présent une espérance de vie assez longue pour pouvoir être atteints de maladies
chroniques comme la coronaropathie et la cardiomyopathie non ischémique, qui peuvent
être la conséquence du traitement antirétroviral combiné lui-même. Les maladies cardiovasculaires
sont une cause majeure de morbidité et de mortalité chez les patients séropositifs
pour le VIH. De plus en plus, ces patients pourraient être candidats à l’une des interventions
de l’éventail complet des chirurgies cardiaques, y compris le pontage coronarien,
la chirurgie valvulaire et la transplantation cardiaque. L’approche consistant à proposer
aux patients séropositifs pour le VIH des interventions palliatives comme la fenêtre
péricardique et la valvuloplastie par ballonnet a été abandonnée au profit de modalités
plus classiques et plus durables. Dans le présent article, nous présentons une vue
d’ensemble actualisée des résultats de la chirurgie cardiaque dans cette population
de patients complexe et unique. Nous examinons certains des enjeux éthiques entourant
la sélection et les soins chirurgicaux des patients vivant avec le VIH. Nous abordons
également la question des stratégies visant à protéger au mieux l’équipe d’intervention
chirurgicale contre le risque de transmission du VIH. Enfin, nous soulignons la nécessité
de privilégier l’approche de l’équipe de cardiologie interdisciplinaire à laquelle
seraient intégrés des professionnels spécialistes des maladies infectieuses, avec
pour objectif d'offrir tout l’éventail des soins à ces patients uniques et complexes.
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Article info
Publication history
Published online: November 19, 2018
Accepted:
November 13,
2018
Received:
August 14,
2018
Footnotes
See page 324 for disclosure information.
Identification
Copyright
© 2018 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
