Article information
Resumen
Hay múltiples evidencias de que los pacientes infectados por el virus de la inmunodeficiencia humana (VIH), tanto varones como mujeres y tanto adultos como niños, tienen un mayor riesgo de desarrollar enfermedad cardiovascular arteriosclerótica. Dichas evidencias provienen tanto de estudios cuyas variables primarias han sido las propias manifestaciones clínicas de enfermedad cardiovascular arteriosclerótica (infarto agudo de miocardio, isquemia miocárdica silente, accidente vasculocerebral [AVC] y arteriopatía periférica), como diversos marcadores de aterosclerosis prematura y disfunción endotelial determinados a distintos niveles (carótidas, coronarias o arterias periféricas) y con diferentes procedimientos diagnósticos (EIM, CAC, FMD, rigidez arterial, índice tobillo/brazo, etc.). Este exceso de riesgo de enfermedad cardiovascular arteriosclerótica de los pacientes VIH-positivos está manifiestamente asociado con la propia infección por el VIH y con los factores de riesgo cardiovascular clásicos y, de forma menos relevante y homogénea, con el uso de inhibidores de la proteasa de primera generación. La hipertensión arterial, cuya relación con la infección por el VIH es mucho menos clara, se asocia, además de con los factores de riesgo cardiovascular tradicionales, con la existencia de lipodistrofia.
Palabras clave:
Infección por VIH
Riesgo cardiovascular
Arteriosclerosis
Cardiopatía isquémica
Abstract
A large body of evidence indicates that HIV-infected patients, both men and women, as well as adults and children, have a higher risk of developing arteriosclerotic cardiovascular disease. This evidence comes from studies whose main primary variables were the clinical manifestations of arteriosclerotic cardiovascular disease (acute myocardial infarction, silent myocardial ischemia, stroke and peripheral arterial disease) and the distinct markers of premature atherosclerosis and endothelial dysfunction determined in different sites (carotid, coronary or peripheral arteries) and with distinct diagnostic procedures (carotid intimamedia thickening, coronary artery calcification, flow-mediated vasodilation, arterial rigidity, ankle/arm index, etc.). This excess risk of arteriosclerotic cardiovascular disease in HIV-positive patients is clearly associated with the HIV infection per se and with classical cardiovascular risk factors, and, to a lesser extent and less uniformly, with the use of first-generation protease inhibitors. Hypertension, whose association with HIV infection is far less clear, is related to both traditional cardiovascular risk factors and to lipodystrophy.
Keywords:
HIV infection
Cardiovascular risk
Arteriosclerosis
Ischemic heart disease
Full text is only aviable in PDF
Bibliografía
[1.]
M. Savés, G. Chêne, P. Ducimetière, C. Leport, G. Le Moal, P. Amouyel, et al.
Risk factors for coronary heart disease in patients treated for human immunodeficiency virus infection compared with the general population.
Clin Infect Dis, 37 (2003), pp. 292-298
[2.]
J.S. Currier, J.D. Lundgren, A. Carr, D. Klein, C.A. Sabin, P.E. Sax, et al.
Epidemiological evidence for cardiovascular disease in HIV-infected patients and relationship to highly active antiretroviral therapy.
Circulation, 118 (2008), pp. e29-e35
[3.]
E. Martínez, M. Larrouse, J.M. Gatell.
Cardiovascular disease and HIV infection: host, virus, or drugs?.
Curr Opin Infect Dis, 22 (2009), pp. 28-34
[4.]
D. Klein, L.B. Hurley, C.P. Quesenberry Jr, S. Sidney.
Do protease inhibitors increase the risk for coronary heart disease in patients with HIV-1 infection?.
J Acquir Immune Defic Syndr, 30 (2002), pp. 471-477
[5.]
J.S. Currier, A. Taylor, F. Boyd, C.M. Dezii, H. Kawabata, B. Burtcel, et al.
Coronary heart disease in HIV-infected individuals.
J Acquir Immune Defic Syndr, 33 (2003), pp. 506-512
[6.]
V.A. Triant, H. Lee, C. Hadigan, S.K. Grinspoon.
Increased acute myocardial infarction and cardiovascular risk factors among patients with human immunodeficiency virus disease.
J Clin Endocrinol Metabol, 92 (2007), pp. 2506-2512
[7.]
N. Obel, H.F. Thompson, G. Kronborg, C.S. Larsen, P.R. Hildebrandt, H.T. Sorensen, et al.
Ischemic heart disease in HIV-infected and uninfected individuals: a populationbased cohort study.
Clin Infect Dis, 44 (2007), pp. 1625-1631
[8.]
N. Friis-Möller, C.A. Sabin, R. Weber, A. d’Arminio-Monforte, W.M. El-Sadr, P. Reiss, et al.
Combination antiretroviral therapy and the risk of myocardial infarction.
N Engl J Med, 349 (2003), pp. 1993-2003
[9.]
N. Friis-Möller, P. Reiss, C.A. Sabin, R. Weber, A. d’Arminio-Monforte, W.M. El-Sadr, et al.
Class of antiretroviral drugs and the risk of myocardial infarction.
N Engl J Med, 356 (2007), pp. 1723-1735
[10.]
D:A:D Study Group.
Use of nucleoside reverse transcriptase inhibitors and risk of myocardial infarction in HIV-infected patients enrolled in the D:A:D study: a multicohort collaboration.
Lancet, 356 (2008), pp. 1723-1735
[11.]
S.A. Bozzette, C.F. Ake, H.K. Tam, S.W. Chang, T.A. Louis.
Cardiovascular and cerebrovascular events in patients treated for human immunodeficiency virus infection.
N Engl J Med, 348 (2003), pp. 702-710
[12.]
U.H. Iloeje, Y. Yuan, G. L’Italien, J. Mauskopf, S.D. Holmberg, A.C. Moorman, et al.
Protease inhibitor exposure and increased risk of cardiovascular disease in HIV-infected patients.
HIV Med, 6 (2005), pp. 37-44
[13.]
A. Carr, B. Grund, J. Neuhaus, W.M. El-Sadr, G. Grandits, C. Gibert, et al.
Asymptomatic myocardial ischaemia in HIV-infected adults.
AIDS, 22 (2008), pp. 257-267
[14.]
M. Duong, Y. Cottin, L. Piroth, A. Fargeot, I. Lhuiller, M. Bobillier, et al.
Exercise stress testing for detection of silent myocardial ischemia in human immunodeficiency virus-infected patients receiving antiretroviral therapy.
Clin Infect Dis, 34 (2002), pp. 523-528
[15.]
G. Nayak, M. Ferguson, D.R. Tribble, C.K. Porter, R. Rapena, M. Marchicelli, et al.
Cardiac diastolic dysfunction is prevalent in HIV-infected patients.
AIDS Patient Care STDS, 23 (2009), pp. 231-238
[16.]
I. Schuster, G.J. Thöni, S. Edérhy, G. Walther, S. Nottin, A. Vinet, et al.
Subclinical cardiac abnormalities in human immunodeficiency virus-infected men receiving antiretroviral therapy.
Am J Cardiol, 101 (2008), pp. 1213-1217
[17.]
J.W. Cole, A.N. Pinto, J.R. Hebel, D.W. Buchholz, C.J. Earley, C.J. Johnson, et al.
Acquired immunodeficiency syndrome and the risk of stroke.
Stroke, 35 (2004), pp. 51-56
[18.]
I. Corral, C. Quereda, A. Moreno, M.J. Pérez-Elías, F. Dronda, J.L. Casado, et al.
Cerebrovascular ischemic events in HIV-1-Infected patients receiving highly active antiretroviral therapy: incidence and risk factors.
Cerebrovasc Dis, 27 (2009), pp. 559-563
[19.]
Hsue PY, Hunt PW, Scnell A, Kalapus SC, Hoh R, Ganz P, et al. Role of viral replication, antiretroviral therapy, and immunodeficiency in HIV-associated therosclerosis. AIDS. 2009. Epub ahead of print.
[20.]
M.W. Lorenz, C. Stephan, A. Harmjanz, S. Staszewski, A. Buehler, M. Bickel, et al.
Both long-term HIV infection and highly active antiretroviral therapy are independent risk factors for early carotid atherosclerosis.
Atherosclerosis, 196 (2008), pp. 720-726
[21.]
J. Lekakis, S. Tsiodras, I. Ikonomidis, J. Palios, G. Poulakou, L. Rallidis, et al.
HIV-positive patients treated with PI have vascular changes resembling those observed in atherosclerotic cardiovascular disease.
Clin Science (Lond), 115 (2008), pp. 189-196
[22.]
R.C. Kaplan, L.A. Kingsley, S.J. Gange, L. Benning, L.P. Jacobson, J. Lazar, et al.
Low CD4+ T cell count as a major atherosclerosis risk factor in HIV-infected women and men.
AIDS, 22 (2008), pp. 1615-1624
[23.]
Grunfeld C, Delaney J, Wanke C, Currier J, Scherzer R, Biggs M, et al. HIV infection is an independent risk factor for atherosclerosis similar in magnitude to traditional cardiovascular disease risk factors. Program and abstracts of the 16th Conference on Retroviruses and Opportunistic Infections. Montreal: February 8-11, 2009. Abstract 746.
[24.]
C. Jericó, H. Knobel, N. Calvo, M.L. Sorli, A. Guelar, J.L. Gimeno-Bayón, et al.
Subclinical carotid atherosclerosis in HIV-infected patients: role of combination antiretroviral therapy.
Stroke, 37 (2006), pp. 812-817
[25.]
P. Maggi, G. Serio, G. Epifani, G. Fiorentino, A. Saracino, C. Fico, et al.
Premature lesions of the carotid vessels in HIV-1-infected patients treated with protease inhibitors.
AIDS, 14 (2000), pp. F123-F128
[26.]
M. Depairon, S. Chessex, P. Sudre, N. Redondi, N. Doser, J.P. Chave, et al.
Premature atherosclerosis in HIV-infected individuals: focus on protease inhibitor therapy.
AIDS, 15 (2001), pp. 329-334
[27.]
E. Seminari, A. Pan, G. Voltini, G. Carnevale, R. Maserati, L. Minoli, et al.
Assessment of atherosclerosis using carotid ultrasonography in a cohort of HIV-positive patients treated with protease inhibitors.
Atherosclerosis, 162 (2002), pp. 433-438
[28.]
G. Chironi, L. Escaut, J. Gariepy, A. Cagny, E. Teicher, J.J. Monsuez, et al.
Carotid intimamedia thickness in heavily pretreated HIV-infected patients.
J Acquir Immune Defic Syndr, 32 (2003), pp. 490-493
[29.]
M.GA. Van Vonderen, Y.M. Smulders, C.DA. Stehouwer, S.A. Danner, C.M. Gundy, et al.
Carotid intima-media thickness and arterial stiffness in HIV-infected patients: the role of HIV, antiretroviral therapy, and lipodystrophy.
J Acquir Immune Defic Syndr, 50 (2009), pp. 153-161
[30.]
G.A. McComsey, M. O’Riordan, S.L. Hazen, D. El-Bejjani, S. Bhatt, M.L. Brennan, et al.
Increased carotid intima-media thickness in HIV infected children.
AIDS, 21 (2007), pp. 921-927
[31.]
I.C.B. Giuliano, S.F.T. De Freitas, M. De Souza, B. Caramelli.
Subclinic atherosclerosis and cardiovascular risk factors in HIV-infected children: PERI study.
Coron Artery Dis, 19 (2008), pp. 167-172
[32.]
P.Y. Hsue, J.C. Lo, A. Franklin, A.F. Bolger, J.N. Martin, S.G. Deeks, et al.
Progression of atherosclerosis as assessed by carotid intima-media thickness in patients with HIV infection.
Circulation, 109 (2004), pp. 1603-1608
[33.]
P. Mercié, R. Thiebaut, V. Aurillac-Lavignolle, J.L. Pellegrin, M.C. Ivorra-Vives, C. Cipriano, et al.
Carotid intima-media thickness is slightly increased over time in HIV-1- infected patients.
HIV Med, 6 (2005), pp. 380-387
[34.]
J.S. Currier, M.A. Kendall, R. Zackin, W.K. Henry, B. Alston-Smith, F.J. Torriani, et al.
Carotid artery intima-media thickness and HIV infection: traditional risk factors overshadow impact of protease inhibitors exposure.
AIDS, 19 (2005), pp. 927-933
[35.]
J.S. Currier, M.A. Kendall, W.K. Henry, B. Alston-Smith, F.J. Torriani, P. Tebas, et al.
Progression of carotid artery intima-media thickening in HIV-infected and uninfected adults.
AIDS, 21 (2007), pp. 1137-1145
[36.]
L.A. Kingsley, J. Cuervo-Rojas, J. Muñoz, F.J. Palella, W. Post, M.D. Witt, et al.
Subclinical coronary atherosclerosis, HIV infection and antiretroviral therapy: Multicenter AIDS Cohort Study.
AIDS, 22 (2008), pp. 1589-1599
[37.]
M. Acevedo, D.L. Sprecher, L. Calabrese, G.L. Pearce, D.L. Coyner, S.S. Halliburton, et al.
Pilot study of coronary atherosclerotic risk and plaque burden in HIV patients: a call for cardiovascular prevention.
Atherosclerosis, 163 (2002), pp. 349-354
[38.]
R. Talwani, O.M. Falusi, C.F. Mendes de León, J.L. Nerad, S. Rich, L.A. Proia, et al.
Electron beam computed tomography for assessment of coronary artery disease in HIVinfected men receiving antiretroviral therapy.
J Acquir Immune Defic Syndr, 30 (2002), pp. 191-195
[39.]
A. Mangili, J. Gerrior, A.M. Tang, D.H. O’Leary, J.K. Polak, E.J. Schaefer, et al.
Risk of cardiovascular disease in a cohort of hIV-infected adults: a study using carotid intima- media thickness and coronary artery calcium score.
Clin Infect Dis, 43 (2006), pp. 1482-1489
[40.]
Q. Meng, J.A. Lima, H. Lai, D. Vlahov, D.D. Celentano, S.A. Strathdee, et al.
Coronary artery calcification, atherogenic lipid changes, and increased erythrocyte volume in black injection drug users infected with human immunodeficiency virus-1-treated with protease inhibitors.
Am Heart J, 144 (2002), pp. 642-648
[41.]
O.M. Adeyemi, K. Rezai, S. Akimov, J. Hwang, B.E. Sha, H.A. Kessler.
Coronary artery calcification on electron beam computed tomography: a 6-year follow-up study of HIV-infected patients.
J Acquir Immune Defic Syndr, 49 (2008), pp. 113-114
[42.]
A.M. Lebech, U.S. Kristoffersen, N. Wiinberg, K. Kofoed, O. Andersen, B. Hesse, et al.
Coronary and peripheral endotelial function in HIV patients studied with positrom emission tomography and flow-mediated dilatation: relation to hypercholesterolemia.
Eur J Nucl Med Mol Imaging, 35 (2008), pp. 2049-2058
[43.]
D. Périard, M. Cavassini, P. Taffé, M. Chevalley, L. Senn, C. Chapuis-Taillard, et al.
High prevalence of peripheral arterial disease in HIV-infected persons.
Clin Infect Dis, 46 (2008), pp. 761-767
[44.]
R. Palacios, I. Alonso, A. Hidalgo, I. Aguilar, M.A. Sánchez, P. Valdivielso, et al.
Peripheral arterial disease in HIV patients older than 50 years of age.
AIDS Res Human Retroviruses, 8 (2008), pp. 1043-1046
[45.]
F. Gutiérrez, E. Bernal, S. Padilla, I. Hernández, M. Masiá.
Relationship between anklebrachial index and carotid intima-media thickness in HIV-infected patients.
AIDS, 22 (2008), pp. 1369-1371
[46.]
A. Sharma, S. Holman, R. Pitt, H.L. Minkoff, J.A. Dehovitz, J. Lazar.
Peripheral arterial disease in HIV-infected and uninfected women.
HIV Med, 8 (2007), pp. 555-560
[47.]
J.H. Stein, M.A. Klein, J.L. Bellehumeur, P.E. McBride, D.A. Wiebe, J.D. Otvos, et al.
Use of human immunodeficiency virus-1 protease inhibitors is associated with atherogenic lipoprotein changes and endothelial dysfunction.
Circulation, 104 (2001), pp. 257-262
[48.]
D. Nolan, G.F. Watts, S.E. Herrmann, M.A. French, M. John, S. Mallal.
Endothelial function in HIV-infected patients receiving protease inhibitor therapy: does immune competence affect cardiovascular risk?.
QJM, 96 (2003), pp. 825-832
[49.]
A. Blum, V. Hadas, M. Burke, I. Yust, A. Kessler.
Viral load of the human immunodeficiency virus could be an independent risk factor for endothelial dysfunction.
Clin Cardiol, 28 (2005), pp. 149-153
[50.]
A. Solages, J.A. Vita, D.J. Thornton, J. Murray, T. Heeren, D.E. Craven, et al.
Endothelial function in HIV-infected persons.
Clin Infect Dis, 42 (2006), pp. 1325-1332
[51.]
J.P. Van Wijk, E.J. De Koning, M.C. Cabezas, J. Joven, J. Op’t Roodt, T.J. Rabelink, et al.
Functional and structural markers of atherosclerosis in human immunodeficiency virus-infected patients.
J Am Coll Cardiol, 47 (2006), pp. 1117-1123
[52.]
J.J. Blanco, I.S. García, J.G. Cerezo, J.M. De Rivera, P.M. Anaya, P.G. Raya, et al.
Endothelial function in HIV-infected patients with low or mild cardiovascular risk.
J Antimicrob Chemother, 58 (2006), pp. 133-139
[53.]
A.C. Andrade, A.M. Ladeia, E.M. Netto, A. Mascarenhas, B. Cotter, C.A. Benson, et al.
Cross-sectional study of endothelial function in HIV-infected patients in Brazil.
AIDS Res Hum Retroviruses, 24 (2008), pp. 27-33
[54.]
M. Charakida, A.E. Donald, H. Green, C. Storry, M. Clapson, M. Caslake, et al.
Early structural and functional changes of the vasculature in HIV-infected children: impact of disease and antiretroviral therapy.
Circulation, 112 (2005), pp. 103-109
[55.]
J.A. Beckman, A.B. Goldfine, A. Dunaif, M. Gerhard-Herman, M.A. Creager.
Endothelial function varies according to insulin resistance disease type.
Diabetes Care, 30 (2007), pp. 1226-1232
[56.]
K.E. Mondy, L. De las Fuentes, A. Waggoner, N.F. Onen, C.S. Bopp, S. Lassa-Claxton, et al.
Insulin resistance predicts endothelial dysfunction and cardiovascular risk in HIVinfected persons on long-term highly active antiretroviral therapy.
AIDS, 22 (2008), pp. 849-856
[57.]
D. Hürlimann, R. Chenevard, F. Ruschitzka, M. Flepp, F. Enseleit, M. Béchir, et al.
Effects of statins on endothelial function and lipid profile in HIV infected persons receiving protease inhibitor-containing anti-retroviral combination therapy: a randomised double blind crossover trial.
Heart, 92 (2006), pp. 110-112
[58.]
Baker J, Duprez D, Rapkin J, Grimm R, Neaton J, Henry K. Untreated HIV infection is associated with impaired arterial elasticity. In: Program and abstracts of the 16th Conference on Retroviruses and Opportunistic Infections. Montreal: February 8-11, 2009. Abstract 725.
[59.]
K. Sevastianova, J. Sutinen, J. Westerbacka, M. Ristola, H. Yki-Järvinen.
Arterial stiffness in HIV-infected patients receiving highly active antiretroviral therapy.
Antivir Ther, 10 (2005), pp. 925-935
[60.]
C. Jericó, H. Knobel, M. Montero, M.L. Sorli, A. Guelar, J.L. Gimeno, et al.
Hypertension in HIV-infected patients: prevalence and related factors.
Am J Hypertens, 18 (2005), pp. 1396-1401
[61.]
M. Baekken, I. Os, L. Sanvik, O. Oektedalen.
Hypertension in an urban HIV-positive population compared with the general population: influence of combination antiretroviral therapy.
J Hypertens, 26 (2008), pp. 2126-2133
[62.]
A.G. Coloma Conde, M. Álvarez Albarrán, A. Roca-Cusach Coll, P. Domingo Pedrol, M. Puig Campmany.
Prevalence of arterial hypertension and lipid profile in HIV patients.
Med Clin (Barc), 131 (2008), pp. 681-684
[63.]
R. Palacios, J. Santos, A. García, E. Castells, M. González, J. Ruiz, et al.
Impact of highly active antiretroviral therapy on blood pressure in HIV-infected patients. A prospective study in a cohort of naive patients.
HIV Med, 7 (2006), pp. 10-15
[64.]
R. Thiebaut, W.M. El Sadr, N. Friis-Moller, M. Rickenbach, P. Reiss, A.D. Monforte, et al.
Predictors of hypertension and changes of blood pressure in HIV-infected patients.
Antivir Ther, 10 (2005), pp. 811-823
[65.]
E. Seaberg, A. Muñoz, M. Lu, R. Detels, J. Margolick, A. Riddler, et al.
Association between highly active antiretroviral therapy and hypertension in a large cohort of men followed from 1984 to 2003.
AIDS, 19 (2005), pp. 953-960
[66.]
J.M. Grandominico, C.J. Fichtenbaum.
Short-term effect of HAART on blood pressure in HIV-infected individuals.
HIV Clin Trials, 9 (2008), pp. 52-60
Copyright © 2009. Elsevier España S.L.. Todos los derechos reservados
