HIV infection and coronary heart disease: an intersection of epidemics

Abstract

Patients with human immunodeficiency virus (HIV) infection are at increased risk of developing coronary heart disease (CHD). Although factors potentially contributing to this elevated risk include traditional CHD risk factors and antiretroviral medications, more recent data support a role for inflammatory and immunologic factors as central to a complex mechanism. Decreasing CHD risk among HIV-infected patients is likely to involve modification of inflammatory and immunologic factors through antiretroviral therapy or other novel strategies as well as targeted treatment of traditional CHD risk factors. This review will highlight epidemiologic data investigating the association between HIV and CHD outcomes. An overview of potential mechanistic factors associated with CHD in HIV infection and of strategies for managing CHD risk in HIV-infected patients is also included. Specific cardiovascular and metabolic risk factors, CHD risk prediction, and the immunologic basis for CHD in HIV-infected patients will be discussed in separate reviews.

Figure 1.

A, Myocardial infarction rates and corresponding adjusted relative risk (RR). Bars indicate crude rates of acute myocardial infarction events per 1000 person-years (PYs) as determined by International Classification of Diseases, Ninth Revision (ICD-9) coding. The RR and associated P value are shown above the bars. The RR was determined from Poisson regression analysis adjusting for age, gender, race, hypertension, diabetes, and dyslipidemia. The associated 95% confidence interval for the RR shown is 1.51–2.02. B, Myocardial infarction rates by age group. Light line indicates patients diagnosed with human immunodeficiency virus (HIV) disease. Dark line indicates patients not diagnosed with HIV disease. Data shown include both sexes. Rates represent number of events per 1000 PYs as determined by ICD coding. From Triant et al [17], by permission of The Endocrine Society.