HIV and Endocarditis

Seropositivity for human immunodeficiency virus (HIV), per se, does not appear to increase the risk of IE. The incidence of IE is rare in HIVpositive patients without intravenous drug abuse (IVDA). Abraham et al. showed that in HIV-positive patients, the identification of bac-teremia is associated with less IE risk than in HIV-negative patients with bacteremia, even with typical IE organisms [50].

The prevalence of IE varies from 6.3% to 34% in HIV patients actively using intravenous drugs, and is independent of treatment with anti-HIV medications [51]. Overall, it seems that the incidence of IE in HIV-positive patients has decreased with modern HIV therapy [51].

The clinical presentation IE in HIV patients is similar to those without HIV. Staphylococcus aureus is the most frequent organism and accounts for approximately 70% of cases [51]. HIV-positive patients with IE tend to be younger and less likely to have underlying predisposing cardiac disease as compared to HIVnegative patients with endocarditis [50]. HIV-positive intravenous drug abusers (IVDAs) have a higher rate of right-sided involvement and of S. aureus infection than HIV-negative IVDAs. Mortality rates are similar in both groups, indicating that the presence of HIV does not affect mortality unless CD4 counts are low (<200/|L). With acquired immunodeficiency syndrome (AIDS), there is a 30% higher mortality rate with IE than non-AIDS HIV patients. The survival rate of HIV patients with IE is similar to patients that found in patients without HIV (85% vs. 93%) [51].

Nonbacterial thrombotic endocarditis, also known as marantic endocarditis, occurs in 3-5% of AIDS patients, especially in patients with HIV wasting syndrome. It predominantly involves left-sided valves with friable endocardial vegetations, consisting of platelets within a fibrin mesh with few inflammatory cells. The lesions are often clinically silent [51].

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