Cardio-vascular diseases at the HIV infected
Рубрика: 6. Клиническая медицина
Дата публикации: 27.09.2017
Статья просмотрена: 13 раз
Мирхамидова С. М., Эргашев А. Я., Номозов Н. М. Cardio-vascular diseases at the HIV infected [Текст] // Медицина: вызовы сегодняшнего дня: материалы IV Междунар. науч. конф. (г. Москва, ноябрь 2017 г.). — М.: Буки-Веди, 2017. С. 51-53. URL https://moluch.ru/conf/med/archive/252/12946/ (дата обращения: 13.12.2017).
Acquired immunodeficiency syndrome (AIDS) — the most important world medical, social and political problem of the XX century. For the last three decades it claimed more than 25 million human lives. In 2015 in the world was about 34 (31,4–35,9) one million people with the human immunodeficiency virus (HIV). Now two types of a virus — HIV-1 and HIV-2 differing according to the structural and antigenic characteristics are known. Against the background of the increased life expectancy of HIV — the infected patients the increasing value are got by chronic disorders, in particular the cardiovascular diseases (CD). The prevalence of HIV infection among adult population grows. The risk of development of a chronic heart failure, syndrome of a sudden cardiac standstill in HIV-positive persons is 1,5–2 times higher, than at not infected. All this demands more detailed studying of a problem of development of cardiovascular diseases in HIV-positive people.
Keywords: cardiovascular diseases, human immunodeficiency virus (HIV), early diagnostics, treatment
Acquired immunodeficiency syndrome (AIDS) — the most important world medical, social and political problem of the XX century. For the last three decades it claimed more than 25 million human lives. In 2015 in the world was about 34 (31,4–35,9) one million people with the human immunodeficiency virus (HIV). The most struck region is Africa to the south from the Sahara — here almost every twentieth adult has HIV. In this region there live 69 % of all people with HIV. 
In 1996 after introduction to practice of highly active antiretroviral therapy («highly active antiretroviral therapy», HAART) the mortality caused by HIV infection significantly decreased. At the same time, against the background of the increased life expectancy of this group of patients the increasing value is gained by chronic disorders, in particular cardiovascular diseases (CVD). 
The heart diseases bound to HIV infection.
I. Heart muscle diseases:
primary HIV myocarditis; secondary myocarditis;
opportunistic infections: (bacterium tuberculosis, mycobacterium avium — intracellulare, oypto-coccus neoformans, aspergillus fumigates, Toxoplasma gondii, nistoplasma capsulation, cytomegalovirus, rneumo-cystis carinii, candida species).
2. Dilatatsionny cardiomyopathy: dysfunction left or both ventricles; the isolated expansion of a right ventricle.
II. Endocardium diseases:
- Not bacteriemic trombotichesky endocarditis.
- Infectious endocarditis.
III. Pericardium diseases:
- Infectious pericardis.
- Noninfectious pericardis.
- Asymptomatic pericardiac exudate.
- Cardiac tamponade (pancarditis).
IV. Malignant neoplasms in heart:
- Kaposha's sarcoma.
V. Cordial arrhythmias:
- Medicinal arrhythmias.
- Secondary in relation to other disease.
As the reason of a lesion of valves of the heart primary three-leaved, at HIV-positive patients serves the infectious endocarditis of a bacteriemic or fungic etiology. Its main originator is Staphylococcus aureus found in more than 40 % of HIV-positive people with an infectious endocarditis. The septic thromboembolism of a pulmonary artery with formation in lungs of multiple focuses an infarct — pneumonia is among the most frequent complications of an infectious endocarditis at the HIV infected. [3,4,5] There were no effective antiretroviral remedies yet, the exudative pericarditis was the most frequent heart disease among HIV — infected. At the same time, in most cases the pericardium lesion at HIV infection proceeds asymptomatically. At the same time gravity of illness varies from an acute or chronic pericardis to an acute cardiac tamponade. Both emergence of an arrhythmia, and its character are often caused by medicines. Against the background of reception of antiretroviral agents with methadone the elongation of an interval of QT on an ECG which is shown tachycardia is possible. [3,4,5] Thus, the prevalence of HIV infection among adult population grows. The risk of development of a chronic heart failure, syndrome of a sudden cardiac standstill in HIV-positive persons is 1,5–2 times higher, than at not infected. All this demands more detailed studying of a problem of development of cardiovascular diseases in HIV-positive people.
The most widespread cardiovascular diseases are:
‒ An ischemic (coronary) heart trouble — owing to which the blood vessels supplying a blood a cardiac muscle suffer;
‒ Atherosclerosis — affects a coronary artery, an aorta and its largest branches, including renal arteries.
‒ An idiopathic hypertension — as a result wich, the vessels which are responsible for supply with a blood a brain suffer;
‒ A varicosity — illness of periphery arteries of the vessels of arms and legs which are responsible for blood supply;
‒ A thromboembolism of lungs — an occlusion of vessels of a lung the come-off thrombus;
‒ A rheumatic carditis — the illness affecting cardiac muscles and valves;
‒ Congenital heart disease — the deformations in a heart structure existing since the birth.
Reasons of development of CVD the most different: improper feeding, insufficient physical activity of the person, existence of addictions (smoking, alcoholism). It belongs and to HIV-positive people, however there are data that HIV infection is immediately coherent with rising of risk of development of CVD. Therefore, in the presence of HIV infection they develop more often, but it is rather simple to prevent them, adhering to a healthy lifestyle, healthy nutrition and undergoing regular clinical inspections. The first scientific data on communication of heart troubles and vessels with HIV were received still in the mid-nineties when reports on implication of a myocardial infarction at the young people infected with a human immunodeficiency virus began to appear.
Earlier the negative impact of HIV infection on work of cardiovascular system was already proved, in particular, some mechanisms of a lesion of a cardiac muscle were studied:
- Penetration of a virus into a myocardium through an internal cover of vessels is carried out.
- In a cardiac muscle there is an infection of HIV of the macrophages and lymphocytes which are there. As a result of it inflammatory reaction due to involvement in process of other macrophages and T lymphocytes begins.
- The virus quickly extends on a myocardium and starts self-destruction process — an apoptosis — therefore cardiomyocytes begin to perish.
Pericardis at the people living with HIV
This disease belongs to possible complications of course of HIV infection. In one cases develops with an exudates, and in others with a cardiac tamponade, that is with a full stopping of its work. Effective antiretroviral therapy (ART) wasn't developed yet. The pericardia can proceed with the minimum quantity of clinical signs. For carrying out diagnostics the echocardiography is used and if it is necessary to confirm the diagnosis, the magnetic resonance imaging (MRI) or the computer tomography (CT) is prescribed.
Distinguish a thrombotic and infectious endocarditic. The last type of a disease often develops at those HIV-positive people who use drugs, and the right-hand valve is most often affected. Inflammation of an internal cover of heart leads to changes of internal structures of an organ therefore a failure of one or several valves develops. The endocarditic in 75 % of cases causes a golden staphylococcus though pneumococcuses and a hemophilic infection quite often participate. The diagnosis of an endocarditic most often is established on the basis of inspection of the patient and results of the conducted laboratory and tool researches. From the beginning of use of highly active antiretroviral therapy (VAART) the quantity of an endocarditic considerably decreased.
Coronary Heart Disease (CHD)
Is illness of blood vessels which supply with a blood a cardiac muscle. Development of this disease at HIV infection is bound to an early atherosclerosis (Morgello, 2002). Walls of vessels are considerably weakened, and in a cardiac muscle there are sites of an ischemia which influence ability of a myocardium. In hard cases of an ischemic heart disease becomes the reason of development of a myocardial infarction and a sudden cardiac standstill. For diagnosis of an ischemic heart disease conduct physical examination of the patient, an electrocardiography, an echography and investigate laboratory indicators. If necessary take functional samples when use various loading tests (the racetrack, the exercise bike, a step the test).
Prophylaxis of development of cardiovascular diseases in HIV-positive people.
In 2006 the first Italian meeting on diagnostics, prophylaxis and treatment of cardiovascular complications at HIV-positive patients during an era VAART» by results of which the document which included references by assessment, prophylaxes and treatment of cardiovascular diseases at the people living with HIV was framed was held ". The main thing what it is necessary to pay attention to, carrying out prophylaxis of SSZ, to treat or not to allow emergence of a dislipid, diabetes mellitus, insulin resistance. The important emphasis was placed on accounting of metabolic disturbances and anthropometric features of each patient. Thanks to modern VAART'S action the number of emergence of SSZ nevertheless has to decrease over time. In 2007 the World Health Organization provided a pocket benefit by assessment and depression of risk of SSZ which can be seen on the website of WHO. The main objective of development of this grant — to provide full information on depression of probability of development of primary and repeated cases which resulted from development of a coronary disease of heart and a cerebrovascular heart trouble.
Generally prophylaxis of CVD at HIV infection same, as well as at its absence:
- The healthy balanced diet — it is necessary to pay attention to fruit and vegetables, fish and bean, low-fat meat and whole grain dishes. In small amounts it is possible to use salt, Sugar.
- Regular physical exercises — for maintenance of cardiovascular system in an optimum state: follows regularly at least on half an hour to do physical exercises.
- Refusal of addictions — smoking and alcohol as well as HIV infection, considerably increase risk of development of CVD, in particular, of a stroke and an infarct. Therefore if for a year not to use tobacco products, then the risk of development of CVD decreases by 50 % at once.
To HIV-positive people it is strongly recommended to know the arterial blood pressure, level of Sugar and lipids in a blood and also to trace a virus load in an organism. Then will become possible considerably to reduce risk of development of cardiovascular diseases and to lead active, full-fledged life.
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