Manifestaciones cardiovasculares en el SIDA

Cardiovascular complications in acquired immunodeficiency syndrome.
AIDS miocardiopathy has been described since 1983. Physiopathologic events leading to AIDS myocardiopathy are largely unknown: viral miocardiopathy, cytokines induced lesions, nutritional status, microvascular and ischemic miocadiopathy have been suspected. We describe a consecutive series of 50 patients (43 males, 7 women) with HIV infection and severe immunodepression (CD4<200/ml) that had clinical, ECG and echocardiographic evaluation. There were 24 drug addicted patients, 17 homosexual patients, and 10 heterosexuals. Some of these patients had the following opportunistic infections: tuberculosis (n=20), Pneumocystis carinii (n=9), Criptocococis (n=9), oropharyngeal candidosis (n=5), toxoplasmosis (n=5), histoplasmosis (n=1) and Kaposi’s sarcoma (n=2). After clinical evaluation 15/50 patients had some kind of cardiovascular complication: 6 patients had congestive heart failure, 5 patients presented with pericardial effusion, one patient has a reversible cardiac arrest, and one patient had pulmonary valvular endocarditis. After Doppler echocardiographic evaluation (according to the American echocardiography association), we found 20 patients with left ventricular diastolic dysfunction, 9 patients with right ventricular diastolic dysfunction and 6 patients with left ventricular systolic dysfunction. In conclusion, our series found left diastolic dysfunction in nearly 40 % of cases and cardiavasular events (pericarditis, heart congestive failure, arrhythmias) in 26% of cases. Cardiovascular complications have prognostic implications in AIDS and shoul be early detected. Further pathological and immunohistochemical studies are needed to clarify the phyiopathological etiologies in AIDS miocardiopathy.