Monocytes in HIV associated atherosclerosis: A review of pathogenesis and clinical implications

Area of Science:

• Cardiovascular Science
• Immunology
• Infectious Disease

Background:

• Atherosclerosis is a leading cause of death globally, with heightened risk in people living with HIV (PLWH) due to persistent immune activation and traditional cardiovascular risk factors.
• HIV-specific mechanisms, including viral proteins and gut microbial translocation, exacerbate chronic inflammation and monocyte dysfunction, accelerating atherosclerosis in PLWH.
• While antiretroviral therapy (ART) has improved longevity, it doesn't fully resolve immune activation, leaving monocyte-driven inflammation central to ongoing atherosclerosis progression.

Purpose of the Study:

• To review the amplified atherosclerosis risk in PLWH.
• To discuss the impact of HIV-specific mechanisms and ART on cardiovascular disease (CVD) risk.
• To explore current and future therapeutic strategies for mitigating CVD in PLWH.

Main Methods:

• Literature review of studies on atherosclerosis in PLWH.
• Analysis of HIV-specific inflammatory pathways and their role in atherogenesis.
• Evaluation of imaging techniques for subclinical atherosclerosis detection (e.g., CIMT, CAC scoring).
• Assessment of adjunctive therapies, including statins and anti-inflammatory agents.

Main Results:

• PLWH exhibit accelerated atherosclerosis due to persistent immune activation, HIV proteins, and gut microbial translocation.
• Protease inhibitor-based ART regimens are linked to metabolic disturbances, worsening dyslipidemia and insulin resistance.
• Subclinical atherosclerosis is prevalent in PLWH, detectable via imaging techniques.
• Statins and anti-inflammatory agents show potential in reducing inflammation and CVD risk.

Conclusions:

• Comprehensive management of PLWH must integrate ART optimization with lifestyle interventions, lipid management, and novel therapies targeting immune dysfunction.
• Targeted strategies addressing monocyte activation, chronic inflammation, and gut microbial translocation are essential.
• Further research is needed to refine biomarkers, personalize CVD risk assessment, and develop innovative treatments to reduce cardiovascular morbidity and mortality in PLWH.