Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2022 Jan 19;7(4):410-421.
doi: 10.1016/j.jacbts.2021.10.017. eCollection 2022 Apr.

HIV, Combination Antiretroviral Therapy, and Vascular Diseases in Men and Women

Laszlo Kovacs  1 , Taylor C Kress  1 , Eric J Belin de Chantemèle  1   2
Affiliations
Review

HIV, Combination Antiretroviral Therapy, and Vascular Diseases in Men and Women

Laszlo Kovacs et al. JACC Basic Transl Sci. .

Abstract

Thanks to the advent of combination antiretroviral therapy (cART), people living with human immunodeficiency virus (HIV) (PLWH) experienced a marked increase in life expectancy but are now at higher risk for cardiovascular disease (CVD), the current leading cause of death in PLWH on cART. Although HIV preponderantly affects men over women, manifestations of HIV-related CVD differ by sex with women experiencing greater risks than men. Despite extensive investigation, the etiopathology of CVD, notably the respective contribution of viral infection and cART, remain ill-defined. However, both viral infection and cART have been reported to contribute to endothelial dysfunction, the precursor and major cause of atherosclerosis-associated CVD, through mechanisms involving endothelial cell activation, inflammation, and oxidative stress, all leading to reduced nitric oxide bioavailability. Therefore, preserving endothelial function in PLWH on cART should be a main target to reduce CVD morbidity and mortality, notably in females.

Keywords: CVD, cardiovascular disease; FMD, flow-mediated dilatation; HF, heart failure; HIV; HIV, human immunodeficiency virus; MI, myocardial infarction; NO, nitric oxide; PAD, peripheral artery disease; PH, pulmonary hypertension; PLWH, people living with HIV; cART, combination antiretroviral therapy; cIMT, carotid intima-media thickness; combination antiretroviral therapy; endothelial dysfunction; sex differences.

PubMed Disclaimer

Conflict of interest statement

Support for this work was provided by NIH 1R01HL147639-01A1, and AHA 19EIA34760167 to Dr Belin de Chantemèle and AHA 21PRE830396 to Mr Kress. Dr Kovacs has reported that he has no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Central Illustration
Central Illustration
Contribution of HIV Infection and cART to HIV-Associated CVD Schematic illustrating the potential mechanisms whereby viral infection and combination antiretroviral therapy contribute to vascular disease in patients living with HIV. AMI = acute myocardial infarction; cART = combination antiretroviral therapy; CVD = cardiovascular disease; HF = heart failure; HIV = human immunodeficiency virus; NO = nitric oxide; PAD = peripheral artery disease; PH = pulmonary hypertension
See this image and copyright information in PMC

References

    1. UNAIDS UNAIDS global report on AIDS. https://www.unaids.org/sites/default/files/media_asset/2020_global-aids-...
    1. Deeks S.G., Lewin S.R., Havlir D.V. The end of AIDS: HIV infection as a chronic disease. Lancet. 2013;382:1525–1533. - PMC - PubMed
    1. Seecheran V.K., Giddings S.L., Seecheran N.A. Acute coronary syndromes in patients with HIV. Coron Artery Dis. 2017;28:166–172. - PMC - PubMed
    1. Glesby M.J. Cardiovascular complications of HIV infection. Top Antivir Med. 2017;24:127–131. - PMC - PubMed
    1. Ghosn J., Taiwo B., Seedat S., Autran B., Katlama C. HIV. Lancet. 2018;392:685–697. - PubMed