Dear Sir,
In January–March 2020 issue of the Journal of Cardiovascular Echography, Poonia et al.[1] reported nicely a case of left atrial angiosarcoma (AA) in an Indian patient. I presume that the rarity of that tumor to occur at an unusual location and its recurrence after surgical excision culminating in death should alert Poonia et al.[1] to take into consideration impaired immune status, particularly human immunodeficiency virus (HIV) infection. It is worthy to mention that due to low immunity, coinfection with oncogenic viruses, and life prolongation secondary to the use of highly active antiretroviral therapy (HAART), HIV-positive individuals are at an increased risk to various types of tumors compared to HIV-negative individuals.[2] Actually, the advent of the HAART has improved the survival of HIV-positive patients. However, they put them at risk for various cardiovascular complications (CVCs), including HIV-related cardiac tumors and atherosclerotic cardiovascular diseases. Indeed, the pathogenesis of these CVCs is complex related to the interaction of various factors, notably HIV itself, complications of HAART such as metabolic alterations, and chronic systemic inflammation.[3] In HIV-endemic countries, increasing the number of persons living with HIV and evolving the prevalence of cardiovascular risk factors will eventually lead to the expanding epidemic of HIV-associated CVCs. In India, HIV infection is a worrisome health threat. The available data pointed out to the substantial national adult HIV seroprevalence rate of 0.22% (0.16%–0.30%) in 2017.[4] I assume that Poonia et al.[1] did not consider HIV infection as they did not address the HIV testing in the studied patient. Therefore, determining HIV status in the studied patient through the diagnostic battery of blood CD4 count and viral overload and measurements was solicited. If that battery was done and it showed HIV reactivity, the case in question could be explicitly considered the second case report of HIV-associated AA. The first case was a 36-year-old American patient with right AA reported in the literature more than a decade ago.[5]
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REFERENCES
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