Professional Documents
Culture Documents
• Laki-laki, 62 tahun
• Masuk RS dengan sesak nafas sejak 1 hari
SMRS
• Riwayat Darah Tinggi dan Kencing manis
• Pengacara dan ada riwayat berganti pasangan
• Diketahui menderita HIV sejak 6 bulan lalu
dan diberi ART
Case 1
• Obesitas
• TD 160/80 mmHg, HR 100 x/menit, RR 24
x/menit
• JVP meningkat
• Ronkhi basah halus dikedua lapang paru
• Edema tungkai minimal
• GDS = 230 mg/dL
Case 1: Masalah
• Gagal Jantung
• Obesitas
• DM tp 2
• Hipertensi
• HIV +
Case 1: Pertanyaan
A. Cardiovascualr disease akibat HIV
B. Cardiovascular disease akibat penyakit yang
sudah ada sebelumnya
C. CVD akibat HIV dan terapinya
D. CVD akibat tatalaksana yang tidak adekuat
terhadap HIV
Case 1: Jawaban
A. Cardiovascualr disease akibat HIV
B. Cardiovascular disease akibat penyakit yang
sudah ada sebelumnya
C. CVD akibat HIV dan terapinya
D. CVD akibat tatalaksana yang tidak adekuat
terhadap HIV
Case 1: lanjutan
• Jika kolesterol yang bersangkutan :
• Kolesterol Total : 189 mg/dL
• LDL : 110 mg/dL
• HDL : 35 mg/dL
• Trigliserida : 350 mg/dL
Dyslipidaemia
Smoking
Insulin
resistance
or non-fatal 17
Renal disease, fatal 4.5
or non-fatal 11
0.1 1 10
Favours DC Favours VS ►
►
El-Sadr W, et al. SMART. NEJM 2006
Cardiovascular complications of HIV
SMART: risk of death strongly associated with IL-6 & D-dimer biomarker
levels at study entry
OR OR OR
(95%CI) (95t% CI) (95% CI)
A. Discontinue lopinavir/ritonavir,
substitute atazanavir
B. Discontinue d4T, substitute tenofovir
C. Ask his employer to replace the donuts
in the vending machine with granola
D. Start simvastatin
E. Start gemfibrozil
F. Nothing needs to be done; dyslipidemia
associated with HIV/ART is not
associated with an increase in CAD
HIV/ART Toxicities:
Dyslipidemia
• Decreased levels of HDL & LDL (especially HDL) and elevated
triglycerides seen in HIV-infected patients prior to introduction of
ART
• Most protease inhibitors have been associated with marked
elevations in triglycerides and LDL but little effect on HDL levels
• NNRTIs and stavudine also associated with dyslipidemic effects
• HIV infection and PI-based ART each associated with pro-
atherogenic profile dyslipidemia
• Substantial evidence that PI-based ART increases risk of coronary
artery disease (CAD)2-4
1. Schambelan M et al. JAIDS 2002; 31(3):257-75. 3. 11th CROI, 2004, Abstract 736.
2. 11th CROI, 2004, Abstract 739. 4. 11th CROI, 2004, Abstract 737.
Incidence of Myocardial Infarction According to the Duration of
Exposure to Combination Antiretroviral Therapy