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Coronary artery disease and human immunodeficiency virus infection
J D Passalaris1, K A Sepkowitz, M J Glesby
1Division of Cardiology, Department of Medicine, Weill Medical College of Cornell University, New York, NY, USA.
Insights
Reports of heart attacks in young individuals with human immunodeficiency virus (HIV) on protease inhibitor therapy are concerning. Further research is needed, but monitoring for hyperlipidemia and modifying cardiac risk factors is advised.
Area of Science:
- Cardiology
- Infectious Diseases
- Pharmacology
Background:
- Reports indicate myocardial infarctions in young human immunodeficiency virus (HIV)-infected patients on protease inhibitor (PI) therapy.
- Pre-existing conditions associated with HIV infection include endothelial dysfunction, hypercoagulability, and hypertriglyceridemia.
- New risk factors like insulin resistance, hypercholesterolemia, and fat redistribution syndrome may worsen cardiovascular risk in patients on PIs.
Purpose of the Study:
- To review the concerns regarding premature coronary artery disease (CAD) in HIV-infected individuals receiving protease inhibitor therapy.
- To highlight potential exacerbating factors for atherosclerotic risk in this patient population.
- To emphasize the need for vigilant monitoring and risk factor modification.
Main Methods:
- Literature review of recent reports and existing data on cardiovascular events in HIV-infected patients on PIs.
- Analysis of known and newly recognized risk factors for cardiovascular disease in the context of HIV and PI therapy.
- Synthesis of information to inform clinical recommendations.
Main Results:
- Myocardial infarctions have been reported in young, HIV-infected patients undergoing PI therapy.
- Established HIV-related factors and newly identified risk factors may contribute to accelerated CAD.
- Current data on the incidence of myocardial infarction is primarily based on case reports, necessitating further investigation.
Conclusions:
- Premature coronary artery disease is a significant concern for HIV-infected patients on protease inhibitor therapy.
- Close monitoring for hyperlipidemia and proactive management of cardiovascular risk factors are crucial.
- Further data collection and research are essential to fully understand and mitigate these risks.
Abstract:
Recent reports of myocardial infarctions in young persons infected with human immunodeficiency virus (HIV) who are receiving protease inhibitor therapy have raised concerns about premature coronary artery disease in this population. Endothelial dysfunction, hypercoagulability, hypertriglyceridemia, and abnormal coronary artery pathology were in fact associated with HIV infection prior to the availability of protease inhibitor therapy. Newly recognized risk factors, such as insulin resistance, hypercholesterolemia, and fat redistribution syndrome, may exacerbate underlying atherosclerotic risk for patients receiving protease inhibitors. Data on the incidence of myocardial infarction among these patients are largely limited to case reports but are of concern. Pending the availability of further data, it is prudent to monitor these patients for hyperlipidemia and consider interventions to modify cardiac risk factors.