Progressive human immunodeficiency virus-associated vasculopathy: time to revise antiretroviral therapy guidelines?

• Published in: CardioVascular Journal of Africa Vol. 22; no. 4; pp. 197 - 200
• Main Authors: Ntusi, N B A, Taylor, D, Naidoo, N G, Mendelson, M
• Format: Journal Article
• Language: English
• Published: South Africa 01-07-2011
• Subjects: Amputation; Anti-Retroviral Agents - therapeutic use; Antiretroviral Therapy, Highly Active; Female; HIV Infections - complications; HIV Infections - diagnosis; HIV Infections - drug therapy; HIV Infections - virology; Humans; Ischemia - drug therapy; Ischemia - pathology; Ischemia - surgery; Ischemia - virology; Lower Extremity - blood supply; Medication Adherence; Peripheral Arterial Disease - drug therapy; Peripheral Arterial Disease - pathology; Peripheral Arterial Disease - surgery; Peripheral Arterial Disease - virology; Practice Guidelines as Topic; Time Factors; Treatment Outcome; Vasculitis - drug therapy; Vasculitis - pathology; Vasculitis - surgery; Vasculitis - virology; Young Adult
• ISSN: 1995-1892; 1680-0745
• DOI: 10.5830/CVJA-2010-048

Cardiovascular abnormalities were appreciated early in the epidemic of the acquired immunodeficiency syndrome (AIDS), even before the aetiological agent, human immunodeficiency virus (HIV) was isolated and characterised. The aetiology and pathogenesis of cardiovascular disease in HIV infection is still the subject of intense speculation, and is likely multi-factorial. HIV affects every aspect of the cardiac axis, causing pericarditis, myocarditis, cardiomyopathy, coronary artery disease and microvascular dysfunction, valvular heart disease, pulmonary vascular disease and pulmonary hypertension, stroke and peripheral vascular disease. HIV-associated vasculopathy is an increasingly recognised clinical entity, causing high morbidity and increasing mortality in southern Africa, particularly from stroke and cardiovascular disease. HIV causes disease of the vascular tree, either by a direct effect on vascular or perivascular tissue, or indirectly via immune complex-mediated mechanisms, associated opportunistic infections and malignancies. As a result, highly active antiretroviral therapy (HAART) may have an important role in controlling disease progression. We report a case of histologically defined primary HIV vasculopathy in which the chance to start HAART was initially missed and in which the patient progressed to require bilateral amputations, but obtained disease quiescence upon commencement of HAART.