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Atherosclerotic Cardiovascular Disease and Anti-Retroviral Therapy

Emma Kaplan-Lewis1, Judith A Aberg1, Mikyung Lee2

  • 1Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1090, New York, NY, 10029, USA.

Current HIV/AIDS Reports
|August 27, 2016
PubMed

Insights

Persons with human immunodeficiency virus (HIV) face increased atherosclerotic cardiovascular disease (ASCVD) risk due to inflammation and antiretroviral therapy (ART) side effects. Early ART initiation is recommended despite varying metabolic impacts.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Immunology

Background:

  • Life expectancy for persons living with HIV (PLWH) approaches the general population due to available therapies.
  • Atherosclerotic cardiovascular disease (ASCVD) presents a significant health burden for PLWH.
  • PLWH exhibit higher cardiovascular risk and events compared to the general population.

Purpose of the Study:

  • To review the epidemiology of ASCVD in HIV-infected patients.
  • To explore the pathogenesis of high-risk plaque in HIV-infected individuals.
  • To discuss the metabolic effects of antiretroviral therapy (ART) and limitations in current cardiovascular disease (CVD) risk screening models.

Main Methods:

  • Review of epidemiological data on ASCVD in HIV-infected patients.
  • Analysis of potential pathogenic mechanisms of high-risk plaque.
  • Evaluation of metabolic effects of ART and current CVD risk assessment tools.

Main Results:

  • Chronic inflammation and immune activation, independent of viral load, significantly contribute to excess ASCVD risk.
  • Both traditional risk factors and HIV-related factors (viral effects, ART) play roles in elevated CVD risk.
  • Evidence from randomized controlled trials (RCTs) supports early ART initiation.

Conclusions:

  • ASCVD is a major concern for PLWH, influenced by multifactorial risks including chronic inflammation and ART.
  • Further research is needed to refine CVD risk screening and management strategies in PLWH.
  • Early ART initiation is beneficial for managing HIV and potentially mitigating ASCVD risk.

Keywords:
Anti-retroviral therapyAtherosclerotic cardiovascular diseaseCVD riskCardiovascular riskHIVPLWHPersons living with HIVRandomized controlled trials

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