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Cardiac Manifestations of HIV Patients

Cardiac Manifestations of HIV Patients

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Published by Udaya Prashant
NON INVASIVE CARDIAC WORK UP OF HIV POSITIVE PATIENTS

Ponangi Udaya Prashant Consultant,CARE Hospitals Banjara Hills, Hyderabad Email: udayaprashant_p@yahoo.co.in

J.J GROUP OF HOSPITALS
DISSERTATION SUBITTED FOR THE DEGREE OF D.M. CARDIOLOGY EXAMINATION (BRANCH II), UNIVERSITY OF MUMBAI May 2008,

INTRODUCTION
HIV aptly called plague of modern era has spread throughout the world in matter of few decades and is now a global pandemic, with cases reported from virtually every country. According to the Cent
NON INVASIVE CARDIAC WORK UP OF HIV POSITIVE PATIENTS

Ponangi Udaya Prashant Consultant,CARE Hospitals Banjara Hills, Hyderabad Email: udayaprashant_p@yahoo.co.in

J.J GROUP OF HOSPITALS
DISSERTATION SUBITTED FOR THE DEGREE OF D.M. CARDIOLOGY EXAMINATION (BRANCH II), UNIVERSITY OF MUMBAI May 2008,

INTRODUCTION
HIV aptly called plague of modern era has spread throughout the world in matter of few decades and is now a global pandemic, with cases reported from virtually every country. According to the Cent

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Published by: Udaya Prashant on Nov 11, 2012
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02/08/2014

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NON INVASIVECARDIAC WORK UP OFHIV POSITIVEPATIENTS
Ponangi Udaya PrashantConsultant, GLOBAL Hospitals, HyderabadEmail: udayaprashant_p@yahoo.co.in
J.J GROUP OF HOSPITALS
DISSERTATION SUBITTED FOR THE DEGREE OF D.M. CARDIOLOGYEXAMINATION (BRANCH II),UNIVERSITY OF MUMBAIMay 2008,
 
 INTRODUCTION
HIV aptly called plague of modern era has spread throughout the worldin matter of few decades and is now a global pandemic, with cases reportedfrom virtually every country. According to the Centres for Disease Control andPrevention (CDC), the case definition of AIDS is (1) HIV-infected individualswho have <200 CD4 T lymphocytes/µL or (2) HIV-infected individuals whohave the presence of specific opportunistic infections like Pneumocystis cariniipneumonia, Kaposi’s sarcoma Cytomegalovirus disease, and pulmonarytuberculosis
1
. Around 42 million people are now living with HIV/ AIDSworldwide
2
. In 2003 alone, there were 5 million new cases of the infectionworldwide and 3 million deaths from AIDS, making it the 4
th
leading cause ofmortality
3, 4
. An estimated 5.7 million people lived with HIV infection in India in2005, which is more than in any other country in the world. Out of these, total1.2 million patients were suffering from severe form of the disease, AIDS,giving an adult prevalence rate of 0.91%
5
.There are certain peculiarities of HIV infection. Besides being the mostdreaded infectious disease at present, it differs a lot from other viral diseases.With the exception of few viruses, most viral infections usually last fromseveral days to weeks during which development of specific adaptiveimmunity along with innate immunity clears virus from the body. However HIVinfection is unique in that once the virus establishes in the body it succeeds inescaping the immune mediated clearance and hence it is virtually nevereliminated from the body completely. Rather a chronic or persistent infection
 
develops that persists with varying degrees of viral replication, which is ahallmark of this disease.
2
Some of theHIV-infected adults are known to havecardiac involvement in the form of diseases of the pericardium, myocardiumand the endocardium. Although pathogenesis of cardiac involvement in HIVinfection is uncertain; autoimmunity, autonomic dysfunction and abnormalventricular growth have been proposed as the possible mechanisms
3,
 The 2 to 5 yr prevalence of symptomatic heart failure ranges from 4 to28 percent suggesting prevalence of 5 million cases of symptomatic HIVrelated heart failure
6
. Before the advent of antiretroviral therapy (ART),clinically significant cardiac disease was unusual in the HIV-infectedpopulation and was detected in most cases only at autopsy. After theintroduction of HAART in 1996, the death rate from AIDS has decreaseddramatically
7
. Use of new anti retroviral therapies has provided these patientsan opportunity to live longer and healthier life. However, increasing thelongevity of life in HIV patients has uncovered many late manifestations of thedisease. Cardiovascular complication is one of these late manifestations ofHIV and is therefore becoming more prevalent. Infection with HIV is one ofthe leading causes of acquired heart disease and specifically of symptomaticheart failure. In 1996, the estimated prevalence’s of a significant cardiacmorbidity and mortality among HIV-positive patients was 6%–7% and 1%–5%,respectively
8
When HIV-infected patients were examined byechocardiography in the late 1980s, cardiac abnormalities were detectedmore often than would be expected from clinical symptoms and physicalexamination.
9
Echocardiography studies showed pericardial effusion as thecommonest cardiac manifestation
40,41,42
, but other studies showed

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