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Chapter 102: HIV/AIDS and the Cardiovascular System

Which of the following is not one of the most common modes of HIV transmission?

A. Blood transfusion

B. Sexual transmission (heterosexual)

C. Sexual transmission (men who have sex with men)

D. Sexual transmission (women who have sex with women)

E. Vertical transmission

The answer is D. (Hurst’s The Heart, 14th Edition, Chap. 102) The most common modes of spread of HIV are sexual—heterosexual (option B) or men who have sex with men (MSM) (option C)—parenteral blood (option A) or blood product recipients, injection drug users, occupational exposure to contaminated products, and vertical transmission (mother to fetus) (option E).

A 36-year-old woman, recently diagnosed with HIV, presents to your clinic after beginning a course of highly active antiretroviral therapy (HAART). Which of the following statements about HAART and cardiovascular health is false?

A. Both HIV-1 infection per se and HAART, particularly where non-nucleoside reverse transcriptase inhibitors (NNRTIs) are included, may have a negative impact on myocardial function

B. Zidovudine causes a dose-dependent reversible skeletal muscle myopathy by altering mitochondrial DNA replication

C. Lipodystrophy can be seen in up to 35% of HIV/AIDS patients after 12 months of protease inhibitor (PI) or NRTI therapies

D. HIV/AIDS disease markers, such as CD4+ count and viral load, are as predictive of cardiovascular risk as are correlates with traditional risk factors (age, gender, diabetes mellitus, smoking, hypertension, dyslipidemia)

E. None of the above is false

The answer is D. (Hurst’s The Heart, 14th Edition, Chap. 102) Both HIV-1 infection per se and HAART, particularly where NRTIs are included, may have a negative impact on myocardial function (option A).1,2 NRTIs are key elements of HAART, and zidovudine has been implicated in the development of some cases of HIV/AIDS cardiomyopathy (CM). In addition to inhibiting HIV-1 reverse transcriptase, the drug causes a dose-dependent, reversible skeletal muscle myopathy by altering mitochondrial DNA replication (option B).3 The prevalence of abnormalities may be dependent on the type and duration of HAART, but lipodystrophy can be seen in up to 35% of HIV/AIDS patients after 12 months of PI or NRTI therapies (option C), particularly with older drugs.4 Overall, controversy persists regarding the effect of HIV/AIDS on the development of atherosclerotic diseases. The D:A:D study of 23,437 patients demonstrated a risk of MI that was related to the duration of HAART treatment. This finding was refined to ...

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