Pathophysiology and Management of Cardiovascular Disease in HIV-Infected Patients

A number of studies suggest that HIV-infected individuals have an elevated risk of cardiovascular disease (CVD), especially coronary heart disease, compared to the HIV-uninfected population. People living with HIV have an increased prevalence of traditional CVD risk factors but HIV-specific mechanisms such as immune activation and antiretroviral therapy also play critical roles. Although older, more metabolically harmful antiretroviral regimens likely contributed to the risk of cardiovascular disease, emerging data suggest that the overall effect of early and continuous use of modern regimens, which may have fewer metabolic consequences, minimizes the risk of myocardial infarction by maintaining viral suppression and decreasing immune activation. Even with antiretroviral therapy, however, immune activation persists in HIV-infected individuals and may contribute to accelerated atherosclerosis, especially of vulnerable coronary lesions that predispose to myocardial infarction. Thus, therapies that safely reduce inflammation in the HIV population may provide additional cardiovascular protection alongside treatment of both traditional and other, non-traditional risk factors.