Heizer Justin, Petersen Timothy C, Flemmer Mark C
Department of Internal Medicine , Eastern Virginia Medical School , Norfolk, VA , USA.
Oxf Med Case Reports. 2016 May 9;2016(5):109-12. doi: 10.1093/omcr/omw036. eCollection 2016 May.
HIV infection can cause multiple deleterious effects on the cardiovascular system. Emerging evidence has supported a direct association between HIV infection and accelerated atherosclerosis. The mechanism for atherosclerosis in HIV-positive patients is multifactorial, an interplay between conventional risk factors, HIV itself and highly active antiretroviral therapy. The case described is a 29-year-old man with HIV, non-adherent to antiretroviral therapy and with few cardiovascular risk factors, who presented with chest pain and non-ST elevation myocardial infarction. Cardiac catheterization revealed multiple coronary artery aneurysms in the left main coronary artery and the right coronary artery. Aneurysmal formation may develop from vasculitis, HIV itself, accelerated atherosclerosis, congenital formation or medications (e.g. protease inhibitors). The researchers provide a review of coronary artery disease, aneurysmal formation and vasculitic processes in the context of HIV. As this clinical entity becomes more apparent, alternative therapeutic options may need to be explored.
艾滋病毒感染可对心血管系统造成多种有害影响。新出现的证据支持了艾滋病毒感染与动脉粥样硬化加速之间的直接关联。艾滋病毒阳性患者发生动脉粥样硬化的机制是多因素的，是传统危险因素、艾滋病毒本身以及高效抗逆转录病毒治疗之间相互作用的结果。所描述的病例是一名29岁的艾滋病毒感染者，未坚持抗逆转录病毒治疗，心血管危险因素较少，他出现了胸痛和非ST段抬高型心肌梗死。心脏导管检查显示左主干冠状动脉和右冠状动脉有多个冠状动脉瘤。动脉瘤形成可能源于血管炎、艾滋病毒本身、动脉粥样硬化加速、先天性形成或药物（如蛋白酶抑制剂）。研究人员对艾滋病毒背景下的冠状动脉疾病、动脉瘤形成和血管炎过程进行了综述。随着这种临床实体变得更加明显，可能需要探索替代治疗方案。
