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Updated: Apr 21, 2026

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Risk of coronary heart disease in patients with HIV infection

Markella V Zanni1, Judith Schouten2, Steven K Grinspoon1

  • 1Program in Nutritional Metabolism, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street 5-LON 211, Boston, MA 02114, USA.

Nature Reviews. Cardiology
|October 22, 2014
PubMed

Insights

Combination antiretroviral therapy (cART) prolongs HIV-infected lives, increasing coronary heart disease (CHD) risk. Managing traditional and HIV-specific factors is crucial for preventing myocardial infarction in this population.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Immunology

Background:

  • Combination antiretroviral therapy (cART) significantly extends the lifespan of individuals with HIV infection.
  • Prolonged survival increases the risk of non-AIDS comorbidities, notably coronary heart disease (CHD).
  • HIV-associated atherogenesis results from intricate interplay between traditional and immune-related risk factors.

Purpose of the Study:

  • To review the impact of HIV and cART on coronary heart disease (CHD) risk.
  • To discuss current and future strategies for CHD prevention in HIV-infected individuals.
  • To highlight the unique challenges in resource-constrained settings.

Main Methods:

  • Review of existing literature on HIV, cART, and cardiovascular disease.
  • Analysis of the complex interactions between traditional risk factors, immune activation, and atherogenesis in HIV.
  • Evaluation of the effects of different cART regimens on metabolic risk factors.

Main Results:

  • Individuals with HIV have a 1.5-fold increased risk of myocardial infarction in Europe and the USA.
  • cART can reduce proatherogenic immune activation, but it is not eliminated even with suppressed viral load.
  • Regimen-specific effects of cART on metabolic risk factors necessitate careful selection.

Conclusions:

  • Early cART initiation with minimal metabolic side effects and diligent management of traditional CHD risk factors are current prevention strategies.
  • Future prevention may involve HIV-tailored CHD risk prediction and adjunctive therapies to reduce immune activation.
  • Rising CHD rates are anticipated in resource-limited regions with increased cART access.

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