Valvular heart disease

Valvular heart disease of HIV-infected patients occurs as a bacterial or mycotic endocarditis. In fact, the hypothesis that HIV infection alone makes a subject more susceptible to infective endocarditis could not be validated. However, intravenous drug abusers have a ten- to twelve-fold increased risk for infective endocarditis than non-intravenous drug abusers (Nahass 1990). The most frequent germ is staphylo-coccus aureus, being detected in more than 40 % of HIV-infected patients with bacterial endocarditis. Further pathogens include Streptococcus pneumoniae and Hemophilus influenzae (Currie 1995). Mycotic forms of endocarditis, which may also occur in patients who are not intravenous drug abusers, mostly belong to As-pergillus fumigatus, Candida species or Cryptococcus neoformans and are associated with a worse outcome (Martin-Davila 2005).

Even if non-drug-abusing HIV patients are not more susceptible to infective endocarditis, the clinical course of the infection is more severe and the outcome worse than in a non-HIV-infected population (Smith 2004).

Signs of infective endocarditis include fever (90 %), fatigue, and lack of appetite. An additional heart murmur may also be present (30 %). In these cases, repeated blood cultures should be taken and transesophageal echocardiography is mandatory (Bayer 1998). Due to the fact that the detection of the infectious agent is often difficult, an antibiotic therapy has to be started early, even without the microbiology results.

In most cases, previously damaged valves are affected. Therefore, antibiotic prophylaxis is recommended in all persons with a previously damaged endocardium and planned interventional procedure, e.g. dental work or operations on the respi ratory or gastrointestinal tract. For diagnosis, antibiotic prophylaxis, and choice and length of antibiotic treatment, please refer to your local cardiologist and to the European guidelines for infective endocarditis

(http://www.escardio.org/knowledge/guidelines/).

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