Antiretroviral therapy with heart

Area of Science:

• Infectious Diseases
• Cardiology
• Pharmacology

Background:

• Antiretroviral therapy (ART) has significantly improved survival for individuals with human immunodeficiency virus (HIV).
• Cardiovascular disease (CVD) is emerging as a major health concern in the aging HIV-positive population.
• Traditional CVD risk factors (smoking, dyslipidemia, diabetes, hypertension) are primary contributors, but HIV and ART also play a role.

Purpose of the Study:

• To review the impact of HIV infection and ART on cardiovascular disease risk.
• To discuss the mechanisms by which HIV and ART may increase CVD risk.
• To provide recommendations for managing CVD risk in patients on ART.

Main Methods:

• Literature review of studies investigating the relationship between HIV, ART, and cardiovascular disease.
• Analysis of data on traditional cardiovascular risk factors, metabolic derangements, atherosclerosis, and endothelial dysfunction in HIV-infected individuals.
• Evaluation of current guidelines and risk assessment tools for CVD in the context of HIV.

Main Results:

• Both HIV infection and ART can modify cardiovascular risk, potentially through effects on traditional risk factors like dyslipidemia and insulin resistance.
• Evidence suggests HIV and ART may accelerate atherosclerosis and cause endothelial dysfunction, though data are conflicting.
• Certain ART drug classes (nucleoside reverse transcriptase inhibitors, protease inhibitors) are associated with increased CVD risk, with variability between drugs.

Conclusions:

• Managing cardiovascular risk in HIV-infected individuals requires a comprehensive approach, including lifestyle modification and pharmacological interventions.
• Regular monitoring of cardiovascular risk before and after initiating ART is recommended.
• ART with a lower potential for metabolic complications should be considered, and existing risk assessment tools must be used cautiously in this population.