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Published on: January 31, 2020
HIV infection and coronary heart disease: mechanisms and management
Priscilla Y Hsue1, David D Waters2
1University of California-San Francisco, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA. priscilla.hsue@ucsf.edu.
Insights
Antiretroviral therapy has made HIV infection a chronic condition, increasing cardiovascular disease risks. Understanding these risks and available therapies is crucial for managing HIV patients and preventing heart attacks and strokes.
Area of Science:
- Cardiology
- Infectious Diseases
- Public Health
Background:
- HIV infection is now a chronic condition due to antiretroviral therapy.
- Individuals with HIV face increased risks of cardiovascular diseases, including myocardial infarction, stroke, and heart failure.
- Awareness of cardiovascular complications and risk management is essential for healthcare providers.
Purpose of the Study:
- To review the epidemiology and clinical features of cardiovascular disease in HIV-infected individuals.
- To explore the mechanisms behind HIV-associated atherosclerotic cardiovascular disease.
- To highlight current and emerging therapeutic strategies for reducing cardiovascular risk in HIV patients.
Main Methods:
- Literature review focusing on cardiovascular disease in the context of HIV infection.
- Analysis of epidemiological data and clinical features.
- Discussion of underlying pathogenetic mechanisms and therapeutic interventions.
Main Results:
- HIV infection substantially increases the risk of myocardial infarction, even with controlled infection.
- Mechanisms include traditional cardiovascular risk factors and HIV-related factors like antiretroviral therapy and chronic inflammation.
- Therapeutic strategies are available to mitigate cardiovascular risk and inflammation.
Conclusions:
- HIV-infected individuals are at elevated risk for cardiovascular disease.
- Both traditional and HIV-specific factors contribute to this increased risk.
- Proactive management and therapeutic interventions are necessary to reduce cardiovascular morbidity and mortality in this population.
Abstract:
Antiretroviral therapy has largely transformed HIV infection into a chronic disease condition. As such, physicians and other providers caring for individuals living with HIV infection need to be aware of the potential cardiovascular complications of HIV infection and the nuances of how HIV infection increases the risk of cardiovascular diseases, including acute myocardial infarction, stroke, peripheral artery disease, heart failure and sudden cardiac death, as well as how to select available therapies to reduce this risk. In this Review, we discuss the epidemiology and clinical features of cardiovascular disease, with a focus on coronary heart disease, in the setting of HIV infection, which includes a substantially increased risk of myocardial infarction even when the HIV infection is well controlled. We also discuss the mechanisms underlying HIV-associated atherosclerotic cardiovascular disease, such as the high rates of traditional cardiovascular risk factors in patients with HIV infection and HIV-related factors, including the use of antiretroviral therapy and chronic inflammation in the setting of effectively treated HIV infection. Finally, we highlight available therapeutic strategies, as well as approaches under investigation, to reduce the risk of cardiovascular disease and lower inflammation in patients with HIV infection.
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