Ntusi N B A, Taylor D, Naidoo N G, Mendelson M
Department of Medicine, University of Cape Town, South Africa.
Cardiovasc J Afr. 2011 Jul-Aug;22(4):197-200. doi: 10.5830/CVJA-2010-048.
Cardiovascular abnormalities were appreciated early in the epidemic of the acquired immunodeficiency syndrome (AIDS), even before the aetiological agent, human immunodeficiency virus (HIV) was isolated and characterised. The aetiology and pathogenesis of cardiovascular disease in HIV infection is still the subject of intense speculation, and is likely multi-factorial. HIV affects every aspect of the cardiac axis, causing pericarditis, myocarditis, cardiomyopathy, coronary artery disease and microvascular dysfunction, valvular heart disease, pulmonary vascular disease and pulmonary hypertension, stroke and peripheral vascular disease. HIV-associated vasculopathy is an increasingly recognised clinical entity, causing high morbidity and increasing mortality in southern Africa, particularly from stroke and cardiovascular disease. HIV causes disease of the vascular tree, either by a direct effect on vascular or perivascular tissue, or indirectly via immune complex-mediated mechanisms, associated opportunistic infections and malignancies. As a result, highly active antiretroviral therapy (HAART) may have an important role in controlling disease progression. We report a case of histologically defined primary HIV vasculopathy in which the chance to start HAART was initially missed and in which the patient progressed to require bilateral amputations, but obtained disease quiescence upon commencement of HAART.
在获得性免疫缺陷综合征（艾滋病）流行早期就已发现心血管异常，甚至在其病原体人类免疫缺陷病毒（HIV）被分离和鉴定之前。HIV感染中心血管疾病的病因和发病机制仍是激烈猜测的主题，可能是多因素的。HIV影响心脏轴的各个方面，导致心包炎、心肌炎、心肌病、冠状动脉疾病和微血管功能障碍、瓣膜性心脏病、肺血管疾病和肺动脉高压、中风和外周血管疾病。HIV相关血管病变是一种越来越被认可的临床实体，在南部非洲导致高发病率和不断上升的死亡率，特别是中风和心血管疾病导致的死亡率。HIV通过对血管或血管周围组织的直接作用，或通过免疫复合物介导的机制、相关机会性感染和恶性肿瘤间接导致血管树疾病。因此，高效抗逆转录病毒治疗（HAART）在控制疾病进展方面可能发挥重要作用。我们报告一例经组织学定义的原发性HIV血管病变病例，该病例最初错过了开始HAART的机会，患者病情进展到需要双侧截肢，但在开始HAART后病情得到缓解。
