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Acute coronary syndrome in HIV patients: from pathophysiology to clinical practice
Enrico Cerrato1, Fabrizio D'Ascenzo, Giuseppe Biondi-Zoccai
1Division of Cardiology, University of Turin, S. Giovanni Battista 'Molinette' Hospital, Italy;
Insights
Highly active anti-retroviral therapy (HAART) improves survival for HIV patients. However, premature cardiovascular disease (CVD) is a major concern due to HIV and drug toxicity, necessitating careful risk factor management.
Area of Science:
- Cardiology
- Infectious Diseases
- Pharmacology
Background:
- Highly active anti-retroviral therapy (HAART) has dramatically improved survival for human immunodeficiency virus (HIV) infected individuals in developed nations.
- Premature atherosclerotic cardiovascular disease (CVD) is now a leading cause of morbidity and mortality in this population.
- Increased CVD risk in HIV patients is attributed to traditional risk factors, HIV infection itself, and antiretroviral drug toxicity.
Purpose of the Study:
- To highlight the significant impact of premature atherosclerotic cardiovascular disease (CVD) in human immunodeficiency virus (HIV) patients on HAART.
- To emphasize the multifactorial nature of increased CVD risk in HIV-infected individuals, including traditional risk factors, HIV-specific factors, and antiretroviral toxicity.
- To underscore the critical need for managing modifiable risk factors and drug interactions in HIV patients with high cardiovascular risk.
Main Methods:
- Literature review and synthesis of current research on cardiovascular disease in HIV-infected patients.
- Analysis of the interplay between HAART, HIV infection, traditional cardiovascular risk factors, and antiretroviral toxicity.
- Clinical guideline review for managing cardiovascular risk in HIV-positive individuals.
Main Results:
- HIV-infected patients on HAART face a heightened risk of premature atherosclerotic cardiovascular disease (CVD).
- Both HIV infection and antiretroviral therapies contribute to proatherogenic effects, exacerbating CVD risk.
- Managing modifiable risk factors and carefully considering drug interactions are crucial for mitigating CVD in this population.
Conclusions:
- Cardiovascular disease (CVD) is a primary concern for long-term survival in human immunodeficiency virus (HIV) patients receiving highly active anti-retroviral therapy (HAART).
- A comprehensive approach is essential, addressing traditional CVD risk factors alongside HIV-specific and treatment-related proatherogenic influences.
- Vigilant management of modifiable risk factors and potential drug interactions is paramount for reducing cardiovascular morbidity and mortality in HIV-infected individuals.
Abstract:
A majority of human immunodeficiency virus (HIV) infected subjects in developed countries have access to highly active anti-retroviral therapy (HAART), which is associated with significantly improved long term survival. In this setting, clinical attention needs to be focused on the impact of premature atherosclerotic cardiovascular disease (CVD), which already represents a leading cause of morbidity and mortality in these patients. While the higher prevalence of traditional risk factors remains the main culprit of increased CVD risk, HIV infection itself and antiretroviral toxicity are confounding proatherogenic factors. It is therefore critical to treat modifiable risk factors, keeping close attention to drug interactions in these patients with high cardiovascular risk profile.
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