Cardiology and AIDS--HAART and the consequences

Since the introduction of highly active antiretroviral therapy (HAART), AIDS has become a treatable disease. A steep decline in morbidity and mortality has been observed in most western countries. The HIV epidemic is now moving into middle-aged populations which are already at increased risk for cardiovascular disease. Since the cardiovascular system is frequently affected in HIV infection, reflections on traditional cardiovascular risk factors is a pressing issue. Moreover, during the last few years, complex lipodystrophic body changes in association with metabolic abnormalities such as dyslipidemia and insulin resistance have become a common feature in HIV+ patients on HAART. Although the precise mechanisms are not fully understood, early reports on myocardial infarctions and vascular changes have raised concern about the possibility of an epidemic of cardiovascular events among HAART patients within the next decade. Not only more data on lipid-lowering drugs in the context of HAART, on switching strategies, and treatment interruptions, but also from intervention studies on traditional risk factors such as smoking, are urgently needed. In this review the key issues concerning cardiovascular aspects of HIV infection in the era of HAART and possible preventive strategies are discussed.