Cardiac Allograft Vasculopathy in HIV-Infected Patients

Abstract

Purpose Cardiac transplantation is performed on HIV-infected pts effectively treated with highly active antiretroviral therapy (HAART). Recent data has shown that protease inhibitors, a component of HAART, may contribute to dyslipidemia. This study determines the prevalence of cardiac allograft vasculopathy (CAV) in post-transplant, HIV-infected patients and the role of dyslipidemia in its progression. Methods and Materials A retrospective analysis of all cardiac transplantation in HIV-infected pts was done. Transplant outcome, graft function, angiogram results, and laboratory tests including lipid profile, were obtained from electronic medical records. Results 11 pts (41±12 yo, 72.7% males) underwent heart transplant at a large volume centers. All pts were treated with HAART post-transplant. The median follow up time was 42.5 months. Nine patients (82%) are alive and only 3 patients (27%) were diagnosed with CAV. Graft dysfunction was reported in only 1 patient (9%). Seven patients (63%) experienced cellular rejection, and only 1 patient (9%) experienced humoral rejection. Seven patients (64%) of patients fulfilled at least one criterion of dyslipidemia. Triglyceride levels were elevated in 5 patients (45%), HDL levels were low in 3 patients (27%), and only 1 patient had a borderline-high LDL level; mean values were 167, 50, and 94 mg/dL respectively. Conclusions CAV occurs in patients with HIV who undergo HT and are treated with HAART at a rate that appears similar or lower than those in the greater transplant population. Marked dyslipidemia does not appear to be a plausible explanation as a driving force for CAV. Rejection which also appears to occur somewhat less frequently may be a more likely cause for CAV in this population. [ figure 1 ]