Evaluation of cardiovacular risk in patients with HIV infection and antiretroviral treatment

Introduction: In industrialized countries the Infectious Endocarditis (IE) has suffered changes in its epidemiological profile with and important drop of the rheumatic valve disease as a risk factor and a raise, in parallel, of people with degenerative valve heart disease and intracardiac devices. Objective: To know the epidemiological characteristics and evaluate the temporal changes in two periods of time selected from 1996 to 2004 and from 2005 to February 2013. Material and methods: A retrospective study revising the clinical histories of patients that were diagnosed with IE from January 1996 until February 2013 in this hospital. The criterion used was Dukes modified for diagnose. The IE had been classified according to the valve type, location, pathogen involved and Community origin, or related to health care. Results: 121 cases with diagnosis of IE were included, 67% men, being 2000 the year with the highest number of cases 17 (14%) followed by 2012 with 15 cases (12.3%). The median age was 66 ± 15 years, from which 51.2% were older than 65 years old. In this series, 72.6% of endocarditis was on native valves, 27.3% on prosthetic valves, 17% on late and only 10.3% on early prosthetic valves. 62.9% of endocarditis in this series was communal, and the ones related to health care (ERAS) represented 31.1% (9.5% nosocomial and 21.6% nosohusial). During the 2005 to 2013 period, a drop in the number of cases of infection over the native valve (78.6 vs. 63.8%) and a raise over the prosthetic valves (21.5 vs. 36.20%) can be observed. Comparing the two periods of study, a drop in communal endocarditis (69.20% vs. 54.90%) and a raise in the ERAS (24.7% vs. 39.2%) can be observed. The endocarditis related to intravenous drug use was stable in the two periods in 6%. Conclusions: The origin of IE continues to be more frequent over the native valve, but with a tendency to a progressive drop and parallel raise of the infection over the prosthetic valve. In relation to age, we could observe a raise of 10% in patients older than 65 years old in the second period studied, these results are similar to the ones published in the recent studies of population. The ERAS have risen during the recent years, while the communal endocarditis has been losing prominence.