Cardiovascular Malignancy
Cardiac Kaposi’s sarcoma in AIDS may cause visceral and parietal pericardial lesions and, less frequently, myocardial lesions. The prevalence has ranged from 12 to 28% in retrospective autopsy studies performed before the introduction of HAART [21].
Cardiac Kaposi’s sarcoma is not usually obstructive or associated with clinical cardiac dysfunction, morbidity, or mortality [40].Malignant lymphoma involving the heart is infrequent in AIDS [21]. Lymphomatous infiltration may be diffuse or may result in discrete isolated lesions, which are usually derived from the Burkitt or immunoblastic type B cells [40]. The lesions are usually
Table 2 Cardiovascular actions/interactions of common HIV therapies. Modified from [3], with permission
| Class | Drugs | Cardiac drug interactions | Cardiac side effects |
| Antiretroviral 1. Nucleoside reverse transcriptase inhibitors (RTI) | Abacavir (Ziagen), zidovudine (AZT, Retrovir) | Dipyridamole | Lactic acidosis (rare), hypotension, skeletal muscle myopathy (mitochondrial dysfunction hypothesized, but not seen clinically) |
| 2. Nucleotide RTI | Tenofovirs (Viread) | ||
| 3. Non-nucleoside RTI | Delavirdine (Rescriptor), efavirenz (Sustiva), nevirapine (Viramune) | Warfarin (class interaction), calcium channel blockers, beta blockers, quinidine, steroids, theophylline | Delavirdine can cause serious toxic effects if given with anti-arrythmic drugs and myocardial ischemia if given with vasoconstrictors |
| 4. Protease inhibitors | Amprenavir (Agenerase), indinavir (Crixivan), nelfinavir (Viracept), ritonavir (Norvir), saquinavir (Invirase, Fortovase), atazanavir (Reyataz) | All are metabolized by cyto- Implicated in premature chrome p-450 and interact atherosclerosis, dyslipidemia, with: sildenafil, amiodarone, insulin resistance, and lidocaine, quinadine, lipodystrophy/lipoatrophy warfarin, statins Calcium channel blockers, beta-blockers (1.5-3 x increase), prednisone, quinine, theophylline (decrease concentrations) | |
| Anti-infective 1.Antibiotics | Erythromycin, clarithromycin | Cytochrome p-450 metabolism and drug interactions | Orthostatic hypotension, ventricular tachycardia, bradycardia, QT prolongation |
| Rifampicin | Reduces therapeutic effect of digoxin by induction of intestinal P-glycoprotein | ||
| Trimethoprim/sulfametho- xazole (Bactrim) | Increases warfarin effects | Orthostatic hypotension, QT prolongation | |
| 2.Antifungal agents | Amphotericin B | Digoxin toxicity | Hypertension, renal failure, hypokalemia, thrombophlebitis |
| Ketoconazole, itraconazole | Cytochrome p-450 metabolism and drug interactions- increases levels of sildenafil, warfarin, “statins”, nifedipine, digoxin | Angioedema, dilated cardiomyopathy, arrhythmias | |
| 3.Antiviral agents | Foscarnet, ganciclovir | Zidovudine | Reversible cardiac failure (dose-related effect), electrolyte abnormalities, ventricular tachycardia (QT prolongation), hypotension |
| 4.Antiparasitic | Pentamidine (intravenous) | Hypotension, arrhythmias (torsade de pointes, ventricular tachycardia), hyperglycemia, hypoglycemia, sudden death | |
Note: Contraindicated if base-line QTc >0.48
nodular or polypoid masses, and they predominantly involve the pericardium, with variable myocardial infiltration. The prognosis of patients with HIV-associated cardiac lymphoma is generally poor, although clinical remission has been observed with combination chemotherapy.
The introduction of HAART led to an approximately 50% reduction in the overall incidence of cardiac involvement by Kaposi’s sarcoma and nonHodgkin’s lymphomas (Fig. 12). The fall may be attributable to the improved immunologic state of the patients and the prevention of opportunistic infections (human herpes virus-8 and Epstein-Barr virus) known to play an etiologic role in these neoplasms [53].