Cardiovascular disease and HIV infection: host, virus, or drugs?

Area of Science:

• Infectious Diseases
• Cardiology
• Public Health

Background:

• Effective antiretroviral therapy (ART) has transformed HIV management, shifting focus to non-communicable diseases.
• Cardiovascular disease (CVD) is an emerging concern for morbidity and mortality in the HIV-infected population.
• Understanding CVD risk factors in HIV is critical for optimizing patient outcomes.

Purpose of the Study:

• To review and compare the risk of cardiovascular disease in HIV-infected individuals versus uninfected individuals.
• To discuss the roles of host factors, HIV infection itself, and antiretroviral therapy in CVD risk.
• To synthesize current knowledge on CVD in the context of HIV management.

Main Methods:

• Literature review and synthesis of existing research on cardiovascular disease in HIV.
• Comparative analysis of CVD incidence and risk factors between HIV-infected and uninfected populations.
• Evaluation of the contributions of host-dependent factors, HIV-specific mechanisms, and antiretroviral therapy regimens.

Main Results:

• While the incidence of CVD is low in HIV patients on ART, their risk is higher compared to uninfected individuals.
• Elevated traditional cardiovascular risk factors, largely host-dependent, significantly contribute to increased CVD risk.
• HIV infection may exacerbate CVD risk through immune activation, inflammation, and immunodeficiency.
• Antiretroviral therapy can modestly influence CVD risk via metabolic and body fat alterations.

Conclusions:

• Cardiovascular disease prevention should be a standard component of care for all HIV-infected patients.
• Proactive screening and aggressive management of traditional CVD risk factors are essential.
• Earlier initiation of antiretroviral therapy is recommended for patients at high cardiovascular risk.
• The cardiovascular benefits of antiretroviral therapy demonstrably outweigh potential risks.