Published online Feb 16, 2017. doi: 10.12998/wjcc.v5.i2.40
Peer-review started: June 3, 2016
First decision: July 5, 2016
Revised: September 29, 2016
Accepted: October 17, 2016
Article in press: October 18, 2016
Published online: February 16, 2017
A 54-year-old black African woman, 22 years human immunodeficiency virus (HIV)-positive, presented with an acute coronary syndrome. She was taking two nucleoside reverse transcriptase inhibitors and two protease inhibitors. Viral load and CD4 count were stable. Angiography revealed a right coronary artery lesion, which was treated with everolimus eluting stent. She also underwent balloon angioplasty to the first diagonal. She re-presented on three different occasions and technically successful coronary intervention was performed. The patient has reported satisfactory compliance with dual anti platelet therapy throughout. She was successfully treated with surgical revascularisation. The patient did not experience any clinical recurrence on follow up. This case demonstrates exceptionally aggressive multifocal and recurrent instent restenosis in a patient treated for HIV infection, raising the possibility of an association with HIV infection or potentially components of retro viral therapy.
Core tip: With an increasing burden of cardiovascular disease in patients with human immunodeficiency virus (HIV), a subgroup of patients may emerge in whom this represents a significant clinical challenge. Better understanding of the responsible mechanisms may allow more tailored pharmacotherapy for susceptible individuals. We report an exceptionally aggressive and recurrent case of coronary stent restenosis in HIV positive patient. Numerous percutaneous interventions were performed but eventually patient was treated successfully with surgical revascularisation.