Abstract
The introduction of combination of antiretroviral therapy and advancement in care
of HIV have dramatically changed the natural history of patients living with HIV.
Today, HIV+ patients have a life expectancy not significantly different from HIV uninfected
people. However, concerns remain about all the comorbidities associated with aging
and the effects of chronic therapies in such high-risk patients. HIV+ subjects exhibited
accelerated atherosclerosis and have a 1.5- to 2-fold increased risk of having coronary
artery disease (CAD), usually presenting early and aggressively with acute coronary
events. Furthermore, HIV+ patients with CAD often complain recurrent acute coronary
events, and they are plagued by major adverse cardiac outcomes.
This review will focus on the current understanding of the CAD phenotype in HIV+ patients
highlighting the topic of acute coronary event recurrence and underscoring the role
of percutaneous management strategies in the light of information derived from invasive
coronary imaging.
Résumé
La combinaison du traitement antirétroviral et de l’amélioration des soins du VIH
a changé de façon spectaculaire l’évolution naturelle de l’état de santé des patients
vivant avec le VIH. Aujourd’hui, l’espérance de vie des patients séropositifs pour
le VIH n’est pas significativement différente de celle des personnes non infectées
par le VIH. Cependant, des préoccupations demeurent quant à toutes les affections
concomitantes associées au vieillissement et aux effets des traitements de longue
durée chez ces patients à risque élevé. Les sujets séropositifs pour le VIH présentent
une accélération de l’athérosclérose et un risque entre 1,5 et 2,0 fois plus élevé
de maladie coronarienne (MC), qui survient généralement de façon précoce et virulente
avec des événements coronariens aigus. De plus, les patients porteurs du VIH qui sont
atteints de MC se plaignent souvent d’événements coronariens récurrents et ils subissent
des manifestations cardiaques indésirables majeures.
Cette revue portera principalement sur les connaissances actuelles relatives au phénotype
de la MC chez les patients séropositifs pour le VIH, en portant une attention particulière
à la récurrence des événements coronariens aigus et en soulignant le rôle des stratégies
de prise en charge percutanée basée sur l’information fournie par l’imagerie coronarienne
invasive.
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Article info
Publication history
Published online: August 29, 2019
Accepted:
July 26,
2019
Received:
April 15,
2019
Footnotes
See page 133 for disclosure information.
Identification
Copyright
© 2019 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
