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Query: UMLS:C0021051 (immunodeficiency)
 71,517 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Acquired immune deficiency syndrome (AIDS) is responsible for significant morbidity and mortality in the United States and other countries. Cardiac involvement in AIDS, which was previously felt to be an unusual manifestation of the disease, is now being described with increasing frequency. Clinical and necropsy studies have demonstrated myocarditis, myocardial necrosis, cardiomyopathy, pericardial disease, endocarditis, pulmonary hypertension, and tumor infiltration in patients dying with AIDS. A direct role for human immunodeficiency virus (HIV-1) in the development of myocarditis, myocardopathy, and pericardial disease has not yet been elucidated. Recent immunopathological evidence suggests a possible role for immune-mediated myocardial inflammatory changes. The drugs used to treat HIV-1 have not been shown to be cardiotoxic; however, there are suggestions that azidothymidine (AZT) can cause mitochondrial changes in myocardial muscle. There are also suggestions that the cardiac complications of AIDS are different in patients whose risk factor for HIV infection is homosexual practice compared with patients having intravenous drug addiction as their major risk factor for HIV disease. Risk factors for myocardial disease, other than HIV, may also be contributors to cardiac complications in patients with AIDS who are intravenous drug abusers.
Cardiovasc Pathol
PMID:AIDS and the heart: Clinicopathologic assessment. 2585 Oct 5

An established relationship exists between human immunodeficiency virus (HIV) and the vascular system, which is characterised by clinical expressions of aneurysmal and occlusive disease that emanate from a common pathological process. The exact pathogenesis is currently unknown; attempts to implicate opportunistic pathogens have been futile. Theories converge on leucocytoclastic vasculitis with the vaso vasora as the vasculopathic epicentre. It is thought that the virus itself or viral proteins trigger the release of inflammatory mediators that cause endothelial dysfunction and smooth muscle proliferation leading to vascular injury and thrombosis. The beneficial effects of highly active anti-retroviral therapy alter the natural history of the disease profile and promote longevity but are negated by cardiovascular complications. Atherosclerosis is an emerging challenge. Presently patients are managed by standard surgical protocols because of non-existent universal surgical interventional guidelines. Clinical response to treatment is variable and often compounded by complications of graft occlusion, sepsis and poor wound healing. The clinical, imaging and pathological observations position HIV-associated large-vessel vasculopathy as a unique entity. This review highlights the spectrum of HIV-associated large-vessel aneurysmal, occlusive and atherosclerotic disease in vascular surgical practice.
Cardiovasc J Afr
PMID:HIV-associated large-vessel vasculopathy: a review of the current and emerging clinicopathological spectrum in vascular surgical practice. 2594 Jan 20

With the progressive increase in life-expectancy of human immunodeficiency virus (HIV)-positive patients in the "highly active antiretroviral therapy" (HAART) era, co-morbidities, particularly cardiovascular (CV) diseases (CVD) are emerging as an important concern. The pathophysiology of CVD in this population is complex, due to the interaction of classical CV risk factors, viral infection and the effects of antiretroviral therapy (ARV). The role of ARV drugs in HIV is double edged. While these drugs reduce systemic inflammation, an important factor in CV development, they may at the same time be proatherogenic by inducing dyslipidemia, body fat redistribution and insulin resistance. In these patients primary prevention is challenging, considering the lower median age at which acute coronary syndromes occur. Furthermore prevention is still limited by the lack of robust evidence-based, HIV-specific recommendations. Therefore we performed a comprehensive evaluation of the literature to analyze current knowledge on CVD prevalence in HIV-infected patients, traditional and HIV-specific risk factors and risk stratification, and to summarize the recommendations for primary prevention of CVD in this HIV population.
Prog Cardiovasc Dis
PMID:HIV Infection and Primary Prevention of Cardiovascular Disease: Lights and Shadows in the HAART Era. 2694 80

Good's syndrome is thymoma accompanied by immunodeficiency. A 69-year-old woman presented with recurrent chest infections, hypogammaglobulinemia, and radiological features of a thymoma. Immunoglobulin replacement therapy was not tolerated prior to surgery. Postoperative recovery was uneventful, and a Masaoka stage II type AB thymoma was confirmed on histology. One-year follow-up revealed no recurrence of the thymoma but the patient remained hypogammaglobulinemic and developed collagenous colitis. She declined immunoglobulin replacement therapy but remains under follow-up. Awareness of Good's syndrome to avoid overwhelming infection is emphasized. The finding of thymoma should prompt the thoracic surgeon to test for immunodeficiency.
Asian Cardiovasc Thorac Ann 2016 Sep
PMID:Good's syndrome: Is thymectomy the solution? Case report and literature review. 2735 13

Good's syndrome or thymoma-associated immunodeficiency is a rare clinical entity that is often presumed to be common variable immunodeficiency, due to lack of awareness and recognition of this syndrome. This syndrome more often goes unrecognized if a thymoma is not detected. An appropriate immunological work-up that aids timely diagnosis and adequate therapy with antimicrobials and intravenous immunoglobulins are mandatory to prevent the long-term complications and mortality associated with this syndrome. We present the clinical and immunological profile of a young man with Good's syndrome that was initially presumed to be common variable immunodeficiency.
Asian Cardiovasc Thorac Ann 2017 Feb
PMID:Thymoma-associated immunodeficiency: a diagnostic challenge for the clinician. 2806 85

The discovery of antiretroviral therapy (ART) for the treatment of human immunodeficiency virus (HIV) has enabled individuals to live longer. As a result, HIV is now often considered a chronic condition. However, as a result of the increase in longevity or the HIV treatment modalities themselves, individuals with HIV are at high risk for the development of atherosclerotic cardiovascular disease. Therefore, these patients should be optimized with pharmacologic therapy to lower their cardiovascular risk through the addition of statin therapy to their regimen. Unfortunately, many medications utilized to treat HIV interact with this class of agents, making prescribing of statin therapy in these patients challenging. While several classes of ARTs do not pose an increased risk of drug-drug interactions with statins, HIV treatment often requires several combinations of medications, enhancing the complexity and drug-drug interaction risk. Clinicians should be aware of interactions with statins and ART and carefully review the degree and clinical significance of each particular medication. With this understanding, the appropriate statin as well as statin dose can be selected in order to optimize the treatment of this patient population, while minimizing the potential risk of adverse effects.
Am J Cardiovasc Drugs 2017 Oct
PMID:Recommendations for Managing Drug-Drug Interactions with Statins and HIV Medications. 2836 70

People living with human immunodeficiency virus (HIV) infection and receiving antiretroviral therapy now have the same life expectancy as the general population. However, they have a higher risk of atherosclerotic cardiovascular events because of a complex and polyfactorial vasculopathy, combining the effects of antiretroviral therapy, the HIV virus itself, immune activation, chronic inflammation and metabolic disturbances. Whether people living with HIV infection experience increased vascular aging compared with the general population remains controversial. To summarize current knowledge of the association between HIV infection and aortic stiffness as a marker of vascular aging. This review included 18 clinical studies in adult populations, published between 2009 and 2016, and identified on PubMed/MEDLINE or other databases. Search terms were aortic stiffness, arterial stiffness, vascular aging, pulse wave velocity and HIV. All 18 studies were observational, and compared groups infected (HIV+) and not infected (HIV-) with HIV. Ten studies (55%) reported no significant differences in aortic stiffness between HIV+ groups and age-matched HIV- control groups. The main reported determinants of aortic stiffness were age, blood pressure, smoking, metabolic syndrome and HIV-related variables, including CD4/CD8 ratio, current T-CD4 count < 200/mm3 and nadir T-CD4+ count < 200/mm3. We found discordant results regarding whether HIV+ patients had increased aortic stiffness compared with HIV- controls. However, HIV-related conditions were associated with vascular health. This association has been confirmed in recent prospective studies. There is emerging evidence that HIV itself and immune activity affect vascular health and the large arteries.
Arch Cardiovasc Dis
PMID:HIV infection and aortic stiffness. 2841 96

Advent of antiretroviral therapy has increased survival of patients with human immunodeficiency virus (HIV) infections, with the result that some of these patients now develop degenerative diseases, such as atherosclerotic aneurysms. Degenerative thoracoabdominal aortic aneurysm is rare in HIV patients. In this report, a 63-year-old male patient with HIV submitted to open repair of thoracoabdominal aortic aneurysm. The patient did not suffer any type of complication in the perioperative period and remained well in a 28-month follow-up period. In summary, open repair still remains a good alternative for aortic complex aneurysms even in HIV patients.
Braz J Cardiovasc Surg
PMID:Thoracoabdominal Aortic Aneurysm in a HIV-positive Patient. 2842 31

Sub-aortic (SA) aneurysms are a rare entity of variable aetiology. We report the first case of a SA aneurysm assessed using cardiac magnetic resonance imaging (MRI). A 33-year-old female with human immunodeficiency virus and on highly active antiretroviral treatment presented with syncope and dyspnoea. Clinical examination suggested moderate to severe aortic regurgitation (AR) confirmed by transthoracic and transoesophageal echocardiograms. However, echocardiography was suboptimal in defining the precise mechanism and severity of AR. A cardiac MRI was done to elucidate the aetiology, severity and mechanism of regurgitation. It confirmed the presence of a SA aneurysm below the left coronary cusp and its retraction, resulting in an eccentric AR jet. An assessment of moderate AR, based on regurgitant volume, was made. Furthermore, the anatomical relationships of the aneurysm were clearly defined. Cardiac MRI allowed comprehensive assessment of this SA aneurysm.
Cardiovasc J Afr
PMID:Efficacy of cardiac magnetic resonance imaging in a sub-aortic aneurysm case. 2866 Feb 73

Acute limb ischemia related to Coxiella burnetii endocarditis is rare. We report an original case of a 68-year-old man hospitalized for recurrent acute left limb ischemia in a context of atrial flutter, which revealed C. burnetii endocarditis. This case illustrates that even if embolic events are uncommon, septic embolisms must be systematically searched for in case of C. burnetii endocarditis. Conversely, extensive etiologic explorations must be performed in case of systemic embolism. New molecular techniques represent a major step forward in infective endocarditis diagnosis. Finally, diagnosis must be suspected in case of unexplained fever, inflammatory syndrome, or embolic event, especially in patients at risk. Conversely, in case of chronic Q fever, an immunodeficiency cause must be researched.
Cardiovasc Pathol
PMID:Coxiella burnetii endocarditis on bioprosthetic aortic valve, with peripheral arterial embolism. 2955 Jul 3


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