Velasquez Enrique M, Glancy D Luke
Department of Medicine, Louisiana State University Health Sciences Center, New Orleans, USA.
J La State Med Soc. 2003 Nov-Dec;155(6):314-24.
Worldwide, infection with the human immunodeficiency virus (HIV) is increasing. At the same time, new treatments allow patients to live longer. Consequently, cardiovascular manifestations, most of which occur relatively late in the course of the infection, are becoming more frequent. Pericardial effusion, the most common cardiovascular manifestation of HIV infection, usually is small and causes no hemodynamic compromise or symptoms. It does, however, augur a grim prognosis, as do other cardiovascular conditions associated with the infection: myocarditis, dilated cardiomyopathy, pulmonary arterial hypertension, cardiac lymphoma, and Kaposi's sarcoma of the heart. Highly active antiretroviral therapy (HAART), especially when incorporating protease inhibitors, greatly improves overall outlook in these patients, but appears not only to cause a lipodystrophic syndrome, but to accelerate atherosclerotic cardiovascular disease by inducing glucose intolerance, frank diabetes mellitus, hypertriglyceridemia, hypercholesterolemia, increased lipoprotein (a), and decreased HDL cholesterol. Recent ongoing prospective trials also are showing an association of HAART with increased coronary artery disease and myocardial infarction.
在全球范围内，人类免疫缺陷病毒（HIV）感染率正在上升。与此同时，新的治疗方法使患者寿命延长。因此，心血管表现变得越来越常见，其中大多数在感染过程中出现得相对较晚。心包积液是HIV感染最常见的心血管表现，通常量小，不会引起血流动力学损害或症状。然而，它预示着预后不良，与该感染相关的其他心血管疾病也是如此：心肌炎、扩张型心肌病、肺动脉高压、心脏淋巴瘤和心脏卡波西肉瘤。高效抗逆转录病毒疗法（HAART），尤其是在联合使用蛋白酶抑制剂时，能大大改善这些患者的总体预后，但似乎不仅会导致脂肪代谢障碍综合征，还会通过诱发糖耐量异常、显性糖尿病、高甘油三酯血症、高胆固醇血症、脂蛋白（a）升高和高密度脂蛋白胆固醇降低来加速动脉粥样硬化性心血管疾病。最近正在进行的前瞻性试验也表明HAART与冠状动脉疾病和心肌梗死增加有关。
