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Review
. 2016 Jul;4(7):598-610.
doi: 10.1016/S2213-8587(15)00388-5. Epub 2016 Feb 10.

Pathophysiology and management of cardiovascular disease in patients with HIV

Eric Nou  1 , Janet Lo  1 , Colleen Hadigan  2 , Steven K Grinspoon  3
Affiliations
Review

Pathophysiology and management of cardiovascular disease in patients with HIV

Eric Nou et al. Lancet Diabetes Endocrinol. 2016 Jul.

Abstract

Results from several studies have suggested that people with HIV have an increased risk of cardiovascular disease, especially coronary heart disease, compared with people not infected with HIV. People living with HIV have an increased prevalence of traditional cardiovascular disease risk factors, and HIV-specific mechanisms such as immune activation. Although older, more metabolically harmful antiretroviral regimens probably contributed to the risk of cardiovascular disease, new data suggest that early and continuous use of modern regimens, which might have fewer metabolic effects, minimises the risk of myocardial infarction by maintaining viral suppression and decreasing immune activation. Even with antiretroviral therapy, however, immune activation persists in people with HIV and could contribute to accelerated atherosclerosis, especially of coronary lesions that are susceptible to rupture. Therefore, treatments that safely reduce inflammation in people with HIV could provide additional cardiovascular protection alongside treatment of both traditional and non-traditional risk factors.

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Conflict of interest statement

Declaration of Interests

There was no role of any funding source in the creation of this review article. SKG has consulted for BMS, Merck, Navidea, Theratechnologies, Gilead, NovoNordisk, AstraZeneca, Aileron, received speaker fees from Takeda, and research funding from BMS, Gilead, Amgen, Navidea, Kowa Pharmaceuticals and Theratechnologies over the past 3 years, all unrelated to this manuscript. EN, JL, and CH have no competing interests. This work was supported in part by the National Institute of Allergies and Infectious Diseases Intramural Program. SKG is a co-investigator for the currently enrolling REPRIEVE trial.

Figures

Figure 1
Figure 1. Summary of epidemiology studies investigating relative risk of cardiovascular disease in HIV patients vs. control subjects
Data are relative risk with 95% CI where available. Dotted line indicates relative risk of one.
Figure 2
Figure 2. Pathophysiology of atherosclerosis in HIV-infected individuals
RCT = reverse cholesterol transport, CEC = cholesterol efflux capacity, Rx = treatment
Figure 3
Figure 3. FDG/PET and Coronary Computed Tomography Angiography Images of Arterial Inflammation and Non-Calcified Plaque Progression in HIV patients
3A: Representative axial and coronal images of the aorta on FDG-PET. There is increased aortic PET-FDG uptake (red coloration) in an HIV-infected subject compared with a HIV-uninfected Framingham Risk score-matched control subject. A=Anterior-Posterior orientation, F=Foot-Head orientation. Figure is reproduced from Subramanian et al by permission of JAMA. 3B and 3C: Coronary computed tomography angiography images of the left anterior descending coronary artery of an HIV-infected individual at baseline (panel B) and at 12 months (panel C). Plaque volume increased from 11 to 124 mm3 (arrows) with high risk morphology features of low attenuation lipid core and positive remodeling at 12 months. Figure is reproduced from Lo et al by permission of Lancet HIV.
See this image and copyright information in PMC

Comment in

  • The need to focus on primary health care for chronic diseases.
    Beran D, Chappuis F, Cattacin S, Damasceno A, Jha N, Somerville C, Suggs LS, Miranda JJ; COHESION Project. Beran D, et al. Lancet Diabetes Endocrinol. 2016 Sep;4(9):731-732. doi: 10.1016/S2213-8587(16)30148-6. Epub 2016 Jul 16. Lancet Diabetes Endocrinol. 2016. PMID: 27432550 No abstract available.

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