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Ana Olga Mocumbi, MD PhD FESC Physical Activity and Sports for Health and Development in Africa, Março 2014.

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Presentation on theme: "Ana Olga Mocumbi, MD PhD FESC Physical Activity and Sports for Health and Development in Africa, Março 2014."— Presentation transcript:

1 Ana Olga Mocumbi, MD PhD FESC Physical Activity and Sports for Health and Development in Africa, Março 2014

2 HIV/SIDA Physical Activity and Sports for Health and Development in Africa, Março 2014

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4 Cardiovascular events have variable prevalence depending on the method of screening; the most frequent manifestations are cardiomyopathy, increase in left ventricular mass, miocarditis, pericardial effusion, malignancies and endicarditis Twagirumukiza M. Curr HIV Res Physical Activity and Sports for Health and Development in Africa, Março 2014

5 Any infectious agent causing systemic infection may affect the cardiac muscle in the context of HIV but cardiac disease is usually hidden by respiratory or cerebral manifestations; prevalence in autopsies was between 28 and 73% in the pre-ART era In Europe and USA morbidity and mortality are 6–10% e 1–9%, respectively; Physical Activity and Sports for Health and Development in Africa, Março 2014

6 Cardiovascular global risk in HIV infected compared to HIV-negative De Gaetano Donati, K., et al Physical Activity and Sports for Health and Development in Africa, Março 2014

7 ART HAART Entry Inhibitors Reverse Transcriptase Inhibitors (RTIs) Nucleoside/ Nucleotide RTIs (NRTIs) Non-Nucleoside RTIs (NNRTIs) Protease Inhibitors Physical Activity and Sports for Health and Development in Africa, Março 2014

8 ART Transformed HIV infection in a chronic condition with which patients live for several years or decades; Acute myocardial infarction and premature atherosclerosis occur in young adults receiving ART, particularly protease inhibitors Maggi P, et al. AIDS 2002; Passalaris JD, et al. Clin Infect Dis DAD Study Group. N Engl J Med 2007; Stein JH, et al. J Acquir Immune Defic Syndr 2005 Physical Activity and Sports for Health and Development in Africa, Março 2014

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10 Doenças cardíacas em pessoas infectadas pelo HIV Doenças pericárdicas · Derrame pericárdico · Pericardite (viral, bacteriana, micótica) · Neoplasias (Sarcoma de Kaposis, limfoma) Doenças miocárdicas · Cardiomiopatia dilatada associada ao HIV · Miocardite (aguda ou crónica) · Neoplasias (Sarcoma de Kaposis, linfoma) · Efeitos secundários de fármacos (em especial os anti-retrovirais) Doenças do endocárdio · Endocardite infecciosa (bacteriana, micótica) · Endocardite não bacteriana trombótica Doenças vasculares · Atherosclerose · Vasculite, perivasculite · Hipertensão arterial sistemica e pulmonar Physical Activity and Sports for Health and Development in Africa, Março 2014

11 Cardiovascular risk in HIV can be attributed to genetic factors, traditional risk factors, adverse effects of ART, and the inflammatory state related to the virus De Gaetano Donati, K., et al Metabolic adverse effects Age Smoking Gender Diabetes Hypertension Others Comorbidies Genetics Endotelial damage Inflamation HIV Host HAART Traditional CV risk factors Physical Activity and Sports for Health and Development in Africa, Março 2014

12 Hipertension Resist. insulin Dislipidemia years Clinical Features Subclinical Disease Atherosclerosis Hipertensive Disease Heart Failure Diab Mellitus type2 Metabolic Syndrome Angina/Infarction Stroke Herat Failure Renal Failure Vasculopathy

13 Cardiac failure & Left Ventricular Dysfunction Ventricular dilatation in VIH+ may be due to infections, cardiotoxic agents, malnutrition, antiretroviral therapy. Only 30 % of the HIV+ patients with ventricular dysfunction are symptomatic, hence the need or more powerful screening using imagery. Nosanchuk 2002, Lewis 2000, Frerichs 2002; Roy 1999 Physical Activity and Sports for Health and Development in Africa, Março 2014

14 Pericardial Effusion In Africa pericardial effusion is much more frequent than in Europe or USA; 96% of the abundant effusions result from tuberculosis. Heidenreich 1995, Stotka 1989, Reuter 2005, Neumann 2002 Physical Activity and Sports for Health and Development in Africa, Março 2014

15 Arrhythmias Tachycardia and fibrillation are the most frequent causes, usually in the context of heart failure and pericardial effusion Cardiac arrhythmias can result from medication such as Efavirenze, foscarnet ou pentamidina. Castillo 2002 Physical Activity and Sports for Health and Development in Africa, Março 2014

16 Other Diseases Thromboembolism (heart, arteries and veins) due to vasculitis or perivasculitis which also causes Aneurisms Systemic Hypertension & Pulmonar Hypertension Ischaemic vascular disease Physical Activity and Sports for Health and Development in Africa, Março 2014

17 Metabolic Syndrome Metabolic changes are frequently the result of ART. Thus, its incidence is expected to increase with the increase in life expectancy associated with universal ART Fisher 2001, Neumann 2002 Physical Activity and Sports for Health and Development in Africa, Março 2014

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19 316 (98,8%) patients were black Physical Activity and Sports for Health and Development in Africa, Março 2014

20 Predominance of females 222 (69.4%) Physical Activity and Sports for Health and Development in Africa, Março 2014

21 Excess of children (15.4%) Sessao do CTC, Novembro 2013

22 Physical Activity and Sports for Health and Development in Africa, Março 2014

23 Data from a Cardiology Clinic in Maputo, 2011 Concomitant HIV was diagnosed in 118 (11.8%) patients, of which 36 were older than 65 years Most important conditions linked to HIV were Dilated Cardiomyopathy (45; 38.1%) Tuberculous Pericardite (23; 19.5%)

24 Pulmonary Embolism & Stroke Physical Activity and Sports for Health and Development in Africa, Março 2014

25 Cardiac Tamponade & Death Physical Activity and Sports for Health and Development in Africa, Março 2014

26 New Picture Age & Infection Physical Activity and Sports for Health and Development in Africa, Março 2014

27 Recommended for most cases … Systemic Hypertension Hypercholesterolemia Metabolic Syndrome Asymptomatic… There is need for research! Physical Activity and Sports for Health and Development in Africa, Março 2014

28 Transition & Acumulation Physical Activity and Sports for Health and Development in Africa, Março patients observed in 12 months in a tertiary hospital

29 Thank you! Physical Activity and Sports for Health and Development in Africa, Março 2014


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