Cardiac side-effects of drugs used to treat HIV infection.

Both nature and prognosis of cardiac complications occurring in patients in fected by the Human Immunodeficiency Virus-1 (HIV-1) have changed considera bly since the introduction of highly acive and anti-retroviral triple thera py (" HART "). Opportunist cardiac infections have thus been displaced and side effects of drugs now occupy the primary aetiological role. Torsades de pointe may be exceptionally triggered by anti-infectious agents such as pentacarinat or trimethoprime-sulfamethoxazole, as are those induc ed by the association of ketoconazole and terfenadine or cisapride, the dan gers of which are well known and the prevention more effective, especially with the association with HIV antiproteases which inhibit the cytochrome P4 50. The diagnosis of iatrogenic myocardial dysfunction is more difficult, e xcept when it occurs acutely as with phosphonoformate (Foscarnet), or inter leukine-2. Progressive cardiomyopathy caused by -interferon and dideoxynucl eosides (zidovudine, didanosine and zalcitabine), reversible on withdrawal of the drug responsible in half the cases, should be distinguished from tho se due to the HIV itself (therapeutic relay) or to another associated cause (alcohol, coronary artery disease). The coronary complications of diseases treated by antiproteases usually occ ur in smokers whose cholesterol and triglyceride levels are rapidly increas ed with HAART. In a series of 9 patients (amongst 700 treated with the anti proteases), after the acute phase of myocardial infarction during which the interventional approach is often preferred, the medium-term prognosis is r elatively good, on condition that the patients correct the hyperlipidaemia and give up smoking.