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Review
. 2022 Sep 1;17(5):286-292.
doi: 10.1097/COH.0000000000000755. Epub 2022 Jul 5.

HIV and cardiovascular disease: the role of inflammation

Sahera Dirajlal-Fargo  1   2 , Nicholas Funderburg  3
Affiliations
Review

HIV and cardiovascular disease: the role of inflammation

Sahera Dirajlal-Fargo et al. Curr Opin HIV AIDS. .

Abstract

Purpose of review: HIV and antiretroviral therapy (ART) use are linked to an increased incidence of atherosclerotic cardiovascular disease (ASCVD). Immune activation persists in ART-treated people with HIV (PWH), and markers of inflammation (i.e. IL-6, C-reactive protein) predict mortality in this population. This review discusses underlying mechanisms that likely contribute to inflammation and the development of ASCVD in PWH.

Recent findings: Persistent inflammation contributes to accelerated ASCVD in HIV and several new insights into the underlying immunologic mechanisms of chronic inflammation in PWH have been made (e.g. clonal haematopoiesis, trained immunity, lipidomics). We will also highlight potential pro-inflammatory mechanisms that may differ in vulnerable populations, including women, minorities and children.

Summary: Mechanistic studies into the drivers of chronic inflammation in PWH are ongoing and may aid in tailoring effective therapeutic strategies that can reduce ASCVD risk in this population. Focus should also include factors that lead to persistent disparities in HIV care and comorbidities, including sex as a biological factor and social determinants of health. It remains unclear whether ASCVD progression in HIV is driven by unique mediators (HIV itself, ART, immunodeficiency), or if it is an accelerated version of disease progression seen in the general population.

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Conflict of interest statement

Conflicts of Interest

Dr. Funderburg has served a consultant and received support from Gilead.

References

    1. Shah ASV, Stelzle D, Lee KK, Beck EJ, Alam S, Clifford S, et al. Global Burden of Atherosclerotic Cardiovascular Disease in People Living With HIV. Circulation. 2018;138(11):1100–12.

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