HIV-pharmacotherapy and pathogenesis of diabetes-induced cardiovascular complications: an updated narrative review

Area of Science:

• Cardiology
• Endocrinology
• Pharmacology

Background:

• Normal cardiac glucose metabolism is vital for heart function and preventing diabetic cardiomyopathy.
• Diabetes mellitus onset often precedes cardiovascular issues like cardiomyopathy, hypertension, and aortic stenosis.
• Chronic HIV antiretroviral therapy (ART) is linked to cardiovascular disease risk factors, including insulin resistance and dyslipidemia.

Purpose of the Study:

• To elucidate the molecular mechanisms linking chronic HIV antiretroviral use to diabetic cardiomyopathy.
• To review the interaction between antiretroviral drugs (ARVs), glucose metabolism, and cardiovascular disease (CVD) risk factors.
• To understand the relationship between ARVs, prediabetes, and CVD development in HIV patients.

Main Methods:

• Literature review of studies on HIV, antiretroviral therapy, glucose metabolism, and cardiovascular disease.
• Analysis of existing data on metabolic derangements associated with chronic ARV use.
• Synthesis of information on the impact of ARVs on insulin resistance, inflammation, and oxidative stress.

Main Results:

• Previous ART regimens have been associated with systemic insulin resistance and impaired glucose tolerance.
• Prediabetes, characterized by impaired glucose tolerance, inflammation, and oxidative stress, is increasingly observed with ARV use.
• While the exact link remains unclear, ARV medication increases prediabetes and diabetes incidence, potentially contributing to CVDs.

Conclusions:

• Chronic HIV antiretroviral use may negatively impact cardiac glucose metabolism and increase CVD risk.
• Understanding the interplay between ARVs, glucose dysregulation, and cardiovascular health is crucial for managing HIV patients.
• Further research is needed to fully clarify the mechanisms and guide therapeutic strategies.