Royal Free Hampstead, London NW3 2QG, United Kingdom.
Int J Cardiol. 2013 Aug 20;167(4):1147-53. doi: 10.1016/j.ijcard.2012.09.043. Epub 2012 Oct 3.
Premature coronary disease is an important emerging paradigm affecting contemporary HIV patients. Through immune reconstruction HIV causes multisystem pathology. Recent advances in the treatment of AIDS, mainly highly active retroviral therapy (HAART), have transformed this previously terminal illness to a chronic disease. However, an interplay between traditional risk factors in a high risk predominantly male population together with the effect of the long term use of HAART in inducing a metabolic syndrome is leading to a premature and aggressive coronary artery disease phenotype not previously recognised. An association between HAART and increased cardiovascular events appears to exist. However, currently this risk appears to be low, and HAART is vital to maintain adequate viral suppression and disease control. HAART- and viral-associated dyslipidaemia can pose a significant challenge to the clinician as drug interactions may precipitate drug toxicity. In our institution a varied phenotypic pattern of coronary disease is seen angiographically from severe atherosclerotic calcific disease through to aneurysm formation and thrombotic occlusion. This is illustrated by case studies. There is a need for aggressive primary and secondary prevention strategies in this important sub-group of patients with a multi-disciplinary approach required in the management including cardiologists, metabolic physicians and lipidologists.
早发冠心病是影响当代 HIV 患者的一个重要新兴模式。HIV 通过免疫重建引起多系统病理学。艾滋病治疗的最新进展，主要是高效抗逆转录病毒疗法（HAART），已经将这种以前的绝症转变为慢性病。然而，在高危的主要男性人群中，传统危险因素的相互作用以及长期使用 HAART 诱导代谢综合征，导致了以前未被认识的早发和侵袭性冠状动脉疾病表型。HAART 与心血管事件增加之间似乎存在关联。然而，目前这种风险似乎较低，而 HAART 对于维持足够的病毒抑制和疾病控制至关重要。HAART 和病毒相关的血脂异常可能对临床医生构成重大挑战，因为药物相互作用可能会引发药物毒性。在我们的机构中，从严重的动脉粥样硬化钙化疾病到动脉瘤形成和血栓闭塞，通过血管造影可以看到不同表型的冠心病。通过病例研究说明了这一点。对于这个具有多学科管理方法的重要亚组患者，需要采取积极的一级和二级预防策略，包括心脏病专家、代谢医生和脂质专家。
