Статья
Инфаркт миокарда у пациентов с ВИЧ-инфекцией: заболеваемость, факторы риска, особенности патогенеза, клиники и лечения
ВИЧ-инфекция увеличивает риск преждевременного развития инфаркта миокарда (ИМ) и других сердечно-сосудистых заболеваний, связанных с атеросклерозом, которые являются основной неинфекционной причиной смертности ВИЧ-инфицированных пациентов. В обзоре приведены результаты анализа литературы последних лет о заболеваемости, распространенности и факторах риска ИМ у ВИЧ-инфицированных. Установлено, что ИМ ассоциирован с комбинированным воздействием традиционных сердечнососудистых факторов риска, ВИЧ-инфекции и кардиометаболическими эффектами антиретровирусной терапии. Выделены особенности патогенеза острого коронарного синдрома при ВИЧ-инфекции в условиях системного иммуноопосредованного воспаления, гиперкоагуляции и прямого воздействия вируса. Описаны особенности клинической картины и поражения коронарных артерий при ИМ. В сравнительном аспекте приведены данные о методах лечения ИМ. Сделан вывод о недостаточном объеме и качестве оказания медицинской помощи пациентам с ВИЧ и ИМ. С позиции возможных лекарственных взаимодействий с антиретровирусной терапией проведен анализ эффективности и безопасности методов вторичной профилактики ИМ.
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