Ceccarelli Giancarlo, d'Ettorre Gabriella, Mancone Massimo, Francone Marco, Vullo Vincenzo
Department of Infectious Diseases and Public Health, University of Rome Sapienza, Italy.
Cardiovasc Revasc Med. 2011 Jul-Aug;12(4):262-5. doi: 10.1016/j.carrev.2010.11.006. Epub 2011 Jan 26.
Highly active antiretroviral therapy has greatly reduced AIDS-related morbidity and mortality; however, its widespread use has been associated with a marked rise in the frequency of cardiovascular diseases in patients with HIV. Moreover, HIV infection is associated with accelerated coronary atherosclerosis and vasculopathy, although the mechanisms underlying these findings have not been determined. We describe the case of a 45-year-old woman with HIV/HCV coinfection, irritable bowel syndrome, and accelerated progression of coronary atherosclerosis after execution of percutaneous coronary intervention (PCI). In this case, the rapidity of progression of atherosclerosis seems linked principally to chronic inflammation and excess immune activation that can depend by a concourse of factors (chronic C hepatitis, irritable bowel syndrome, PCI execution) not directly associated with traditional risk factors. Caregivers following HIV-infected patients should be aware of the increased risk of accelerated atherogenesis in these subjects, principally in case of presence of causes of intense immune activation.
高效抗逆转录病毒疗法已大幅降低了与艾滋病相关的发病率和死亡率；然而，其广泛使用与感染艾滋病毒患者心血管疾病发生率的显著上升有关。此外，艾滋病毒感染与冠状动脉粥样硬化和血管病变加速有关，尽管这些发现背后的机制尚未确定。我们描述了一名45岁的女性病例，她同时感染了艾滋病毒/丙型肝炎病毒，患有肠易激综合征，在进行经皮冠状动脉介入治疗（PCI）后冠状动脉粥样硬化加速进展。在这个病例中，动脉粥样硬化进展的速度似乎主要与慢性炎症和过度免疫激活有关，而这可能取决于一系列并非直接与传统风险因素相关的因素（慢性丙型肝炎、肠易激综合征、PCI手术）。照顾感染艾滋病毒患者的医护人员应意识到这些患者动脉粥样硬化加速发生的风险增加，尤其是在存在强烈免疫激活原因的情况下。
