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Review
. 2009 May;4(3):176-82.
doi: 10.1097/COH.0b013e328329c62f.

The consequences of HIV infection and antiretroviral therapy use for cardiovascular disease risk: shifting paradigms

Jason V Baker  1 , W Keith Henry, James D Neaton
Affiliations
Review

The consequences of HIV infection and antiretroviral therapy use for cardiovascular disease risk: shifting paradigms

Jason V Baker et al. Curr Opin HIV AIDS. 2009 May.

Abstract

Purpose of review: To explore the mechanisms by which HIV infection and antiretroviral therapy (ART) may increase risk for atherosclerotic cardiovascular disease (CVD), with attention to the implications of earlier initiation of ART (i.e. at higher CD4 cell counts than currently recommended by guidelines).

Recent findings: Compared with the general population, HIV-infected patients who receive ART have a greater burden of subclinical and clinical atherosclerotic disease. Findings from a recent international treatment interruption trial (SMART) have redirected attention from ART-related drug toxicity toward a better appreciation for the consequences of untreated HIV infection, which may increase CVD risk through inflammation, upregulation of thrombotic pathways, and ultimately early vascular damage and dysfunction. In addition, CVD risk may increase with some ART, and this risk may be class-specific and/or drug-specific.

Summary: Compared with untreated HIV, ART may increase or decrease risk of CVD. Reliable data on the relative risk do not exist. A randomized trial of early ART will provide the best data for assessment of the net risks and benefits of ART use on CVD.

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Figures

Figure 1
Figure 1
Multiple factors contribute to CVD risk among patients with HIV infection, including traditional risk factors as well as mechanisms related to viral replication and ART. While ART use may decrease HIV-mediated CVD risk via suppression of viral replication, it is also associated with drug toxicity that itself is known to confer CVD risk. There may also be other HIV- and ART-specific CVD risk factors not discussed here (dotted lines). Thus, the net influence of ART on CVD risk, in the setting of HIV infection, remains to be defined.
See this image and copyright information in PMC

References

    1. Grinspoon SK, Grunfeld C, Kotler DP, Currier JS, Lundgren JD, Dube MP, et al. State of the science conference: Initiative to decrease cardiovascular risk and increase quality of care for patients living with HIV/AIDS: executive summary. Circulation. 2008;118(2):198–210. - PMC - PubMed
    1. Palella FJ, Jr, Delaney KM, Moorman AC, Loveless MO, Fuhrer J, Satten GA, et al. Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV Outpatient Study Investigators. N Engl J Med. 1998;338(13):853–860. - PubMed
    1. Friis-Moller N, Sabin CA, Weber R, d'Arminio Monforte A, El-Sadr WM, Reiss P, et al. Combination antiretroviral therapy and the risk of myocardial infarction. N Engl J Med. 2003;349(21):1993–2003. - PubMed
    1. Crum NF, Riffenburgh RH, Wegner S, Agan BK, Tasker SA, Spooner KM, et al. Comparisons of causes of death and mortality rates among HIV-infected persons: analysis of the pre-, early, and late HAART (highly active antiretroviral therapy) eras. J Acquir Immune Defic Syndr. 2006;41(2):194–200. - PubMed
    1. Sackoff JE, Hanna DB, Pfeiffer MR, Torian LV. Causes of death among persons with AIDS in the era of highly active antiretroviral therapy: New York City. Ann Intern Med. 2006;145(6):397–406. - PubMed

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