HIV-related cardiovascular diseases: the search for a unifying hypothesis

Abstract

Although the extensive rollout of antiretroviral (ARV) therapy resulted in a longer life expectancy for people living with human immunodeficiency virus (PLHIV), such individuals display a relatively increased occurrence of cardiovascular diseases (CVD). This health challenge stimulated significant research interests in the field, leading to an improved understanding of both lifestyle-related risk factors and the underlying mechanisms of CVD onset in PLHIV. However, despite such progress, the precise role of various risk factors and mechanisms underlying the development of HIV-mediated CVD still remains relatively poorly understood. Therefore, we review CVD onset in PLHIV and focus on 1) the spectrum of cardiovascular complications that typically manifest in such persons and 2) underlying mechanisms that are implicated in this process. Here, the contributions of such factors and modulators and underlying mechanisms are considered in a holistic and integrative manner to generate a unifying hypothesis that includes identification of the core pathways mediating CVD onset. The review focuses on the sub-Saharan African context, as there are relatively high numbers of PLHIV residing within this region, indicating that the greater CVD risk will increasingly threaten the well-being and health of its citizens. It is our opinion that such an approach helps point the way for future research efforts to improve treatment strategies and/or lifestyle-related modifications for PLHIV.

Nutritional Intervention Reduces Dyslipidemia, Fasting Glucose and Blood Pressure in People Living with HIV/AIDS in Antiretroviral Therapy: A Randomized Clinical Trial Comparing Two Nutritional Interventions

“…Despite the immense benefits that antiretroviral therapy (ART) use has brought to people living with HIV/AIDS (PLWHA), there are some associated increased risks of dyslipidemia, hyperglycemia/diabetes, gastrointestinal symptoms, obesity, and hypertension, which contribute to a higher cardiometabolic risk in this population [ 1 , 2 , 3 , 4 , 5 , 6 , 7 ]. Other risk factors also corroborate for cardiometabolic diseases in PLWHA, such as smoking, excessive alcohol consumption, and physical inactivity [ 1 , 8 , 9 , 10 , 11 , 12 ].…”

Expansion of GARP-Expressing CD4+CD25−FoxP3+ T Cells and SATB1 Association with Activation and Coagulation in Immune Compromised HIV-1-Infected Individuals in South Africa

“…Some HIV-positive individuals exhibit persistent immune activation, immune failure and the development of chronic co-morbidities such as CVD (Dominick et al 2020). However, the exact role of Treg cells in this context remains unclear as they can trigger beneficial or detrimental outcomes.…”

Sudden cardiac death in HIV‐infected patients: A contemporary review

“…Furthermore, multiple studies have reported an increased prevalence of traditional cardiovascular risk factors, such as diabetes, HTN, and smoking among HIV‐infected individuals compared to the general population 32‐35 . In addition to the traditional CVD risk factors, chronic systemic inflammation from viral infection contributes to endothelial dysfunction, immune activation, and vascular injury which further precipitates premature atherosclerosis in HIV‐infected individuals 36‐40 . HIV infection is associated with almost 50% increased risk of acute myocardial infarction as compared to the general population, even after adjustment for Framingham risk score, substance abuse, and comorbidities 41 .…”