Search PubMed⌕ Search

Biomedical subjects

Daniel Vittecoq

Publications and source records attributed to Daniel Vittecoq.

10 recordsLinked to original sources
PubMed2003

Coronary artery disease in HIV infected patients.

OBJECTIVE: To assess the incidence, clinical features, treatment, and follow-up of coronary events in HIV-infected patients over a period of 5 years. PATIENTS AND PARTICIPANTS: A cohort of 840 patients. MEASUREMENTS AND RESULTS: A coronary event occurred in 17 patients (5.9/1000 persons-years). Sixteen of them were exposed to highly active antiretroviral therapy (HAART). Patients with coronary events differed in age (48.3 vs. 43 years), CD4 T-cell count (284 vs. 486/mm(3)), total cholesterol (6.2 vs. 5.3 mmol/l), HDL cholesterol (0.72 vs. 1.16 mmol/l), and LDL cholesterol (4.95 vs. 3.391.61 mmol/l). No difference was observed regarding duration of HAART, weight, glucose level, or smoking status between the two groups. Acute coronary syndrome was the first manifestation in 14 patients. Coronary angiography showed 2.56 stenosis per patient, with a single vessel involvement in one-half. Percutaneous angioplasty was performed in all cases, with stenting in 11. After a mean follow-up of 36 months, 14 patients remain alive. Restenosis ( n=4) occurred in 3 patients (PTCA 3; stenting 4). All 14 patients are free of heart failure symptoms. Their mean left ventricular ejection fraction is 61%. CONCLUSIONS: A higher coronary-event rate is observed among HIV-infected patients, associated with drug-induced metabolic disturbances and a high prevalence of tobacco smoking. However, treatment and prognosis of acute myocardial infarction has no specificity.

Adult↗
PubMed2003

Brief report: carotid intima-media thickness in heavily pretreated HIV-infected patients.

The authors used ultrasonography to measure carotid artery intima-media thickness (IMT) in 36 HIV-infected patients taking highly active antiretroviral therapy (cases) and in two control groups without (control group 1) or with (control group 2) blood lipid and glucose disturbances similar to those of the patients. Case IMT values were 8% higher than control group 1 IMT values (p <.05) but not different from control group 2 IMT values. Positive independent associations of IMT with the total-to-HDL cholesterol ratio and waist circumference existed for cases (p <.05) but not for controls. Case IMT did not correlate with parameters of HIV infection and antiretroviral treatment. This case-control study suggests that lipid disturbances, mainly hypoHDLemia, may be involved in the early atherosclerotic process in HIV-infected patients.

Adult↗
PubMed2003

Coronary heart disease in HIV-infected patients in the highly active antiretroviral treatment era.

OBJECTIVES: To assess the incidence and the clinical features of coronary heart disease in HIV-infected patients. To assess atherosclerosis risk factors in this population. METHODS: A review of our experience consisting of 16 patients with acute myocardial infarction (AMI) was the basis of our retrospective analysis of two cohorts in France. Incidence was compared with the national database on the incidence of AMI in the general population. RESULTS: Incidence appears to be between 5 and 5.5 per 1000 person-years among HIV-infected patients. This accounts for at least a threefold increase in incidence (1.52 per 1000 person-years reported in the Monica database registry in France). Age of onset of AMI in HIV-infected patients (younger than 50 years in most cases) is a point of major concern and is an indirect way to confirm the increased incidence. AMI was typically of sudden onset without prior history of angina pectoris. Treatment and prognosis of AMI in this population has no specificity. Patients with coronary heart disease present several risk factors such as tobacco smoking, hypertension, diabetes mellitus and low high-density lipoprotein level. The links between AMI and protease inhibitor exposure is still a matter of debate, and longer duration of follow-up is needed in order to reach any conclusion. CONCLUSIONS: Coronary heart disease is of a higher than expected incidence in HIV-infected patients. The limitation of risk factors (mainly tobacco smoking) is a new challenge. An adaptation of the Framingham score is necessary to state the individual risk. Prospective, controlled studies are necessary to assess new strategies such as the role of statins and switching therapeutic regimens.

Adult↗
PubMed2002

Mitochondrial damage associated with long-term antiretroviral treatment: associated alteration or causal disorder?

Combination of antiretroviral drugs has dramatically improved the prognosis of human HIV infection but is also associated with many adverse effects, the mitochondrial origin of which is discussed. In this study using extensive diagnostic procedures set up for inherited mitochondrial disorders, we analyzed HIV patients under active antiretroviral therapy who complained of severe adverse symptoms unexplained by HIV. All these patients had been treated for at least 5 years. They all had significant mitochondrial damage as evidenced by the diverse combination of lactate accumulation in blood or cerebrospinal fluid, mitochondrial morphologic alterations in muscle, and biochemical defects in muscle and liver, which designated mitochondrial DNA (mtDNA) as the main target of the toxic mechanisms. Southern blot and/or polymerase chain reaction -based analyses disclosed multiple deletions of the muscle mtDNA and reduction of the muscle and/or liver mtDNA copy number in a majority of the patients. In opposition to muscle and liver, blood mononuclear cells were devoid of significant biochemical or genetic alterations. Whether the mitochondrial toxicity is directly responsible for the patients' adverse symptoms remains disputable, because the investigations were transversal. Its severity argues for its clinical relevance, however. The skewed tissue distribution of mitochondrial alterations indicates potential pitfalls in the needed future prospective studies.

Adult↗
PubMed2002

[Anti-Jo1 antibodies syndrome in an HIV-infected patient].

An HIV-infected man developed primary polymyositis (fever, myalgia, elevated serum muscle enzymes, and signs of inflammation) associated with serum anti-Jo1 antibodies and pulmonary fibrosis. Anti-Jo1 antibodies are exceptional in HIV-infected patients. We discuss the role of infection in polymyositis. HAART and corticosteroids led to rapid clinical and radiological improvement.

Adrenal Cortex Hormones↗