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28.2 Epidemiology of HIV-associated cardiovascular complications
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Published:July 2018
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Abstract
Antiretroviral therapy (ART) has reduced by about 30% in developed countries the incidence of some cardiovascular complications observed in the pre-ART period (dilated cardiomyopathy, pericardial effusion, and cardiac involvement by AIDS-associated malignancies). However, the incidence of some cardiovascular complications (endocarditis and pulmonary hypertension) was not significantly changed after the introduction of ART. In developing countries, where the availability of ART is scanty and the pathogenetic impact of nutritional factors is significant, an increase was observed of about 35% in the prevalence of cardiomyopathy and pericardial effusion, with a related high mortality rate for congestive heart failure. The increased incidence of ART-associated lipodystrophy in developed countries (range 18–83%) has changed the landscape of cardiovascular complications in HIV disease, with an apparently increased incidence of coronary artery disease in patients receiving protease inhibitor-based ART because of a process of accelerated atherosclerosis. This new clinical landscape led to a greater awareness by cardiologists in taking decisions regarding the use of antiretrovirals for a careful stratification of the cardiovascular risk factors.
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