Why is it that HIV patients, despite ART, have premature death compared to the rest of the population?
What is responsible for dyslipidemias seen in HIV patients?
1) HIV infection: decreased lipolysis associated with mitochondrial dysfunction from altered nuclear receptors that control lipid metabolism and inflammation. 2) Drug therapy (especially protease inhibitors)
Statins that are best to use to control dyslipidemia in patients with HIV
Prevastatin, pitavastatin, atorvastatin and rosuvastatin.
Signs of lipodystrophy
Visceral fat, facial lipoatrophy, peripheral fat wasting, buffalo hump and gynecomastia.
Causes of acute renal failure in HIV patients
HIVAN, TTP, Hep C cryoglobulinemia, medication-induced (tenofovir)
Causes of chronic kidney disease in HIV patients
Membranous nephropathy, membranoproliferative GN, diabetic nephropathy, hypertensive nephropathy and IgA nephropathy.
Pathogenesis of HIV nephropathy
Deposition of circulating immune complexes that are filtered by the glomeruli
Histologic findings in HIVAN
Collapsing FSGS with tubulo-interstitial injury
Signs of HIVAN
Nephrotic proteinuria, rise in sCr, large kidneys, hypoglobulinemia
Common causes of liver disease in patients with HIV
Infection (HAV, HBV, HCV, CMV, MAC and biliary tract infections), substance abuse, NASH, drug toxicity (INH, statins, ART, tylenol), allergic rxns (nevirapine), IRIS
Bone diseases associated with HIV
Osteonecrosis from avascular necrosis, osteomalacia from vitamin D deficiency (tenofovir) and osteopenia from drop in bone density (tenofovir)
When are DEXA scans recommended for patients with HIV?
> 50 years old
Tx for HIV patients with bone disease
Vit D, Ca, exercise, bisphosphonates
Cardiac diseases associated with HIV
Pericardial effusion (AIDS), myocardial disease, pulmonary vascular disease, valvular heart disease and vascular disease.
Why do HIV patients have so many difficulties with restenosing of catheterized arteries?
Chronic inflammatory state = endothelial dysfunction. Insulin resistance and dyslipidemia contribute to atherosclerosis.