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Atherosclerosis and Cardiovascular Complications in People Living with HIV: A Focused Review
Michele Salvatore Paternò Raddusa1, Andrea Marino2, Benedetto Maurizio Celesia2
1Department of Clinical and Experimental Medicine, University of Messina, 98124 Messina, Italy.
Insights
Advancements in HIV treatment extend life but increase cardiovascular disease (CVD) risk. Understanding HIV and antiretroviral therapy (ART) impacts on heart health is crucial for managing risks in people living with HIV (PLWH).
Area of Science:
- Cardiovascular Medicine
- Infectious Diseases
- Pharmacology
Background:
- Antiretroviral therapy (ART) has increased lifespan for people living with HIV (PLWH).
- This increased longevity has led to a higher prevalence of cardiovascular disease (CVD) among PLWH.
- HIV infection and its treatment present unique challenges to cardiovascular health.
Purpose of the Study:
- To explore the complex relationship between HIV, ART, and cardiovascular health.
- To elucidate mechanisms linking HIV and ART to increased cardiovascular risk.
- To discuss therapeutic strategies for mitigating CVD in PLWH.
Main Methods:
- Review of scientific literature on HIV, ART, and CVD.
- Analysis of mechanisms including endothelial dysfunction, inflammation, and metabolic disturbances.
- Examination of the roles of HIV proteins (Tat, Nef, gp120) and ART regimens.
Main Results:
- HIV and ART contribute to atherosclerosis via inflammation, immune activation, and metabolic changes.
- Chronic inflammation persists in PLWH, predicting non-AIDS-related diseases like CVD.
- Specific ART regimens can alter lipid profiles and body composition, affecting CVD risk.
Conclusions:
- A multidisciplinary approach integrating HIV care and cardiovascular risk management is essential for PLWH.
- Optimizing ART while minimizing cardiovascular risk is key to improving long-term health for PLWH.
- Therapeutic interventions like statins, aspirin, and PCSK9 inhibitors show promise in managing CVD in this population.
Abstract:
The intersection of Human Immunodeficiency Virus (HIV) infection and cardiovascular disease (CVD) represents a significant area of concern; advancements in antiretroviral therapy (ART) have notably extended the life expectancy of people living with HIV (PLWH), concurrently elevating the prevalence of chronic conditions such as CVD. This paper explores the multifaceted relationship between HIV infection, ART, and cardiovascular health, focusing on the mechanisms by which HIV and ART contribute to increased cardiovascular risk, including the promotion of endothelial dysfunction, inflammation, immune activation, and metabolic disturbances. We highlight the critical roles of HIV-associated proteins-Tat, Nef, and gp120-in accelerating atherosclerosis through direct and indirect pathways that exacerbate endothelial damage and inflammation. Additionally, we address the persistent challenge of chronic inflammation and immune activation in PLWH, factors that are strongly predictive of non-AIDS-related diseases, including CVD, even in the context of effective viral suppression. The impact of ART on cardiovascular risk is examined, with particular attention to the metabolic implications of specific ART regimens, which can influence lipid profiles and body composition, thereby modifying CVD risk. The therapeutic potential of statins, aspirin, and emerging treatments such as PCSK9 inhibitors in mitigating cardiovascular morbidity and mortality among PLWH is discussed, alongside considerations for their use in conjunction with ART. Our review underscores the necessity for a comprehensive, multidisciplinary approach to cardiovascular care in PLWH, which integrates vigilant cardiovascular risk assessment and management with HIV treatment. As we navigate the evolving landscape of HIV care, the goal remains to optimize treatment outcomes while minimizing cardiovascular risk, ensuring that the gains in longevity afforded by ART translate into improved overall health and quality of life for PLWH.
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