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HIV, Combination Antiretroviral Therapy, and Vascular Diseases in Men and Women

Laszlo Kovacs1, Taylor C Kress1, Eric J Belin de Chantemèle1,2

  • 1Vascular Biology Center, Medical College of Georgia at Augusta University, Augusta, Georgia, USA.

JACC. Basic to Translational Science
|May 11, 2022
PubMed

Insights

Combination antiretroviral therapy (cART) increases life expectancy for people with HIV (PLWH) but heightens cardiovascular disease (CVD) risk. Preserving endothelial function is crucial for reducing CVD, especially in women.

Area of Science:

  • Cardiovascular Science
  • Infectious Disease
  • Immunology

Background:

  • Combination antiretroviral therapy (cART) has improved longevity for people living with HIV (PLWH).
  • Cardiovascular disease (CVD) is now the leading cause of death in PLWH on cART.
  • HIV-related CVD risks and manifestations differ by sex, with women facing higher risks.

Purpose of the Study:

  • To investigate the etiopathology of CVD in PLWH on cART.
  • To clarify the contributions of HIV infection and cART to CVD development.
  • To identify key mechanisms underlying CVD risk in this population, particularly endothelial dysfunction.

Main Methods:

  • Review of existing literature on HIV, cART, and CVD.
  • Analysis of mechanisms contributing to endothelial dysfunction.
  • Examination of sex-based differences in CVD manifestations.

Main Results:

  • Both HIV infection and cART contribute to endothelial dysfunction, a precursor to atherosclerosis-associated CVD.
  • Mechanisms include endothelial cell activation, inflammation, and oxidative stress, reducing nitric oxide bioavailability.
  • Women with HIV exhibit distinct and potentially greater risks for CVD compared to men.

Conclusions:

  • Endothelial dysfunction is a critical pathway for CVD development in PLWH on cART.
  • Targeting endothelial function preservation is essential for mitigating CVD morbidity and mortality.
  • Particular attention should be paid to reducing CVD risk in women living with HIV.

Keywords:
CVD, cardiovascular diseaseFMD, flow-mediated dilatationHF, heart failureHIVHIV, human immunodeficiency virusMI, myocardial infarctionNO, nitric oxidePAD, peripheral artery diseasePH, pulmonary hypertensionPLWH, people living with HIVcART, combination antiretroviral therapycIMT, carotid intima-media thicknesscombination antiretroviral therapyendothelial dysfunctionsex differences

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