Cardiovascular disease and HIV infection

Abstract

Advances in antiretroviral therapy have resulted in a significant increase in life expectancy and quality of life of people living with human immunodeficiency virus (HIV) (PLWH). However, long-term observation of this population revealed an increased risk of cardiovascular diseases (CVDs). Moreover, development of atherosclerosis may be secondary to numerous factors. Traditional risk factors of ischemic heart disease, such as hypertension, diabetes, and cigarette smoking, are more common in HIV-infected population than in non-HIV-infected one. Many antiretroviral drugs have an unfavorable metabolic profile, leading to dyslipidemia, lipodystrophy, and impaired glucose metabolism. Markers of immuno-activation, coagulation, and endothelium dysfunction, may remain elevated despite an effective antiretroviral treatment (ART). Inflammation affects arterial endothelium, leading to an increased deposition of lipids in the arterial wall. HIV infection may also affect blood pro-thrombotic activity. All these factors lead to more rapid atherosclerosis formation and increased risk of myocardial infarction. In order to lower cardiovascular risk in PLWH, traditional risk factors should be modified, and ART with less impact on patients' metabolisms should be used. If necessary, a lipid-lowering treatment should be introduced. Treatment with statins brings an additional benefit of reducing inflammatory markers associated with an increased CVD risk. When selecting a statin, possible interactions with ART need to be considered.

Unveiling the Heart of the Matter: Echocardiographic Insights into Diastolic Function and Left Ventricular and Atrial Changes in HIV Patients with Controlled Viremia

“…PLWH have twice the risk for cardiovascular disease compared to uninfected individuals [4]. HIV infection may contribute to premature CVD in many ways: the chronic inflammation that persists despite suppressive ART causes endothelial dysfunction and increases prothrombotic activity; widespread prevalence of typical CVD risk factors; drug abuse; coinfections; and unfavorable effects of ART on the metabolic profile, promoting dyslipidemia and glucose intolerance [5][6][7]. This results in premature atherosclerosis and myocardial ischemia.…”