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Pathophysiology and management of cardiovascular disease in patients with HIV

Eric Nou1, Janet Lo1, Colleen Hadigan2

  • 1Program in Nutritional Metabolism, Massachusetts General Hospital, Boston, MA, USA.

The Lancet. Diabetes & Endocrinology
|February 14, 2016
PubMed

Insights

People with HIV face higher cardiovascular disease risks due to traditional factors and immune activation. Modern antiretroviral therapy can minimize myocardial infarction risk by suppressing the virus and reducing inflammation.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Immunology

Background:

  • Individuals with HIV exhibit elevated cardiovascular disease (CVD) risk, particularly coronary heart disease, compared to HIV-negative populations.
  • Increased prevalence of traditional CVD risk factors and persistent immune activation are noted in people living with HIV (PLWH).
  • Older antiretroviral therapy (ART) regimens were linked to higher CVD risk, likely due to metabolic side effects.

Purpose of the Study:

  • To examine the impact of modern antiretroviral therapy (ART) on cardiovascular disease risk in people with HIV (PLWH).
  • To understand the role of persistent immune activation in accelerated atherosclerosis despite ART.
  • To explore potential additional cardiovascular protection strategies for PLWH.

Main Methods:

  • Review of existing studies on HIV and cardiovascular disease.
  • Analysis of the effects of modern versus older antiretroviral regimens.
  • Investigation of immune activation markers and their correlation with atherosclerosis.

Main Results:

  • Modern ART, when used early and continuously, appears to minimize myocardial infarction risk.
  • Viral suppression and decreased immune activation are key benefits of modern ART regimens.
  • Persistent immune activation in PLWH may contribute to accelerated atherosclerosis and vulnerable coronary lesions.

Conclusions:

  • Early and continuous modern ART is crucial for reducing cardiovascular risk in PLWH.
  • Addressing persistent inflammation through targeted treatments may offer additional cardiovascular protection.
  • Comprehensive management of traditional and non-traditional risk factors is essential for cardiovascular health in PLWH.

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