[Epidemiology of atherosclerotic cardiovascular risk in HIV-1 infected patients]

OBVIOUS EFFICACY, BUT ALSO RISKS: The administration of combinations of highly active antiretroviral since 1996 has greatly decreased morbidity and mortality in HIV-1 infected patients. Side effects associated with these treatments were rapidly described. Other than abnormal distribution of fat, the dyslipidemia and insulin-resistance leads to a pro-atherogenic profile in these patients. Since 1998, the publication of several observations of acute cardio-vascular events in HIV-1 infected patients most often treated by antiretrovirals has raised the question of the increased risk of atherosclerosis in these patients. Today, some studies have been published and several are ongoing to evaluate the cardiovascular risk in HIV-1 infected patients. TWO FUNDAMENTAL QUESTIONS: The purpose of this review was to critically report the results of published studies in order to answer the two major questions: do HIV-1 infected patients have an increased cardiovascular risk compared to non infected subjects, and what are these cardiovascular risk factors? REPLY ELEMENTS: The review of available published results is in favour of an increased risk in HIV-1 infected patients compared to the general population. However, it is difficult to evaluate the importance of the absolute risk compared to the benefits of antiretroviral treatments and also the inherent effect of antiretroviral molecules. The main risk factors seem to be classical risk factors such as smoking habits, age and dyslipidemia that are partly due themselves to highly active antiretroviral treatments