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HIV and cardiovascular disease: the role of inflammation

Sahera Dirajlal-Fargo1,2, Nicholas Funderburg3

  • 1Rainbow Babies and Children's Hospital.

Current Opinion in HIV and AIDS
|August 8, 2022
PubMed

Insights

People with HIV (PWH) on antiretroviral therapy (ART) face higher risks of atherosclerotic cardiovascular disease (ASCVD) due to persistent immune activation and inflammation. Understanding these mechanisms is key to reducing ASCVD risk in PWH.

Area of Science:

  • Immunology
  • Cardiovascular Medicine
  • Infectious Diseases

Background:

  • Antiretroviral therapy (ART) use in people with HIV (PWH) is associated with increased atherosclerotic cardiovascular disease (ASCVD) incidence.
  • Chronic immune activation persists in ART-treated PWH, with inflammation markers predicting mortality.
  • This review explores the mechanisms linking HIV, ART, and accelerated ASCVD.

Purpose of the Study:

  • To review the underlying mechanisms contributing to persistent inflammation and ASCVD development in PWH.
  • To highlight novel insights into immunologic drivers of chronic inflammation.
  • To discuss potential differences in vulnerable populations and future therapeutic strategies.

Main Methods:

  • Review of current literature on HIV, inflammation, and ASCVD.
  • Analysis of emerging immunologic mechanisms (e.g., clonal hematopoiesis, trained immunity, lipidomics).
  • Consideration of disparities in HIV care and comorbidities.

Main Results:

  • Persistent inflammation is a key factor in accelerated ASCVD among PWH.
  • New insights include clonal hematopoiesis, trained immunity, and lipidomics as contributors to inflammation.
  • Inflammatory mechanisms may differ in vulnerable groups like women, minorities, and children.

Conclusions:

  • Ongoing mechanistic studies are crucial for developing targeted therapies to reduce ASCVD risk in PWH.
  • Addressing disparities, including sex as a biological factor and social determinants of health, is essential.
  • Further research is needed to determine if HIV-related ASCVD is unique or an accelerated form of general population disease.
Abstract

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