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Canadian Journal of Cardiology

Cardiovascular Events Recurrence and Coronary Artery Disease in HIV Patients: The Price We Have to Pay for the Chronicization of the Disease

Published:August 29, 2019DOI:https://doi.org/10.1016/j.cjca.2019.07.636

      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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