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Does antiretroviral therapy increase or decrease the risk of cardiovascular disease?

Carl J Fichtenbaum1

  • 1Division of Infectious Diseases, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinnati, OH 45267-0560, USA. Carl.fichtenbaum@uc.edu

Current HIV/AIDS Reports
|April 29, 2010
PubMed

Insights

Antiretroviral therapy

Area of Science:

  • Cardiovascular Science
  • Infectious Disease Research
  • HIV Medicine

Background:

  • Atherosclerosis is a significant concern for individuals with HIV infection.
  • HIV infection itself is a chronic inflammatory condition contributing to cardiovascular disease (CVD) risk.
  • Certain antiretroviral medications are associated with increased coronary heart disease (CHD) risk.

Purpose of the Study:

  • To review the current evidence and controversy surrounding HIV and antiretroviral therapy's role in cardiovascular disease development.
  • To clarify the complex relationship between HIV, its treatment, and atherosclerosis.

Main Methods:

  • Review of epidemiologic studies and clinical trial data.
  • Analysis of the impact of different antiretroviral drug classes on cardiovascular risk.

Main Results:

  • Some antiretroviral drugs (nucleoside reverse transcriptase inhibitors, protease inhibitors) are linked to higher CHD risk.
  • Other antiretroviral classes (NNRTIs, entry inhibitors, integrase inhibitors) appear neutral regarding CHD risk.
  • Short-term initiation of antiretroviral therapy may reduce CHD risk, but long-term data is limited.

Conclusions:

  • The net effect of antiretroviral therapy on cardiovascular disease risk in people with HIV remains perplexing.
  • Further adequately powered randomized trials are needed to definitively establish the role of antiretroviral therapy in HIV-related cardiovascular disease.

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