HIV Infection and Myocardial Infarction

After the advent of the potent combination antiretroviral therapy (cART) the incidence of acquired immune deficiency syndrome (AIDS) has declined dramatically and HIV infection became a chronic disease with a significant increase in the life expectancy of HIV-positive people. Consequently, chronic comorbidities as coronary heart disease raised an increasing concern in this population.

Aim of this editorial article is to review the most recent data about the cardiovascular disease risk among HIV-positive persons and to suggest an appropriate clinical management.

An increased risk of myocardial infarction has been reported among HIVinfected subjects compared to the general population, but the pathogenic mechanism of this accelerated atherosclerotic process is complex and certainly multifactorial. The occurrence of myocardial infarction may be the consequence of traditional risk factors (that are overrepresented in the HIVinfected population), direct viral replication, and long-term toxicity of the antiretroviral drugs. Moreover, despite the persistent viral suppression induced by cART usually reduces the cardiovascular risk, several studies show in HIV-positive subjects a condition of chronic inflammation and immune activation that could lead to both accelerated endothelial dysfunction and atherosclerotic disease.

The cardiovascular risk reduction and coronary heart disease prevention are today a leading challenge for all the clinicians involved in the HIV patients' care.