HIV and Ischemic Heart Disease

Abstract

The association of coronary heart disease (CHD) and human immunodeficiency virus (HIV) infection has been well recognized for many years. The etiology of the increased prevalence of CHD in HIV-infected populations is the result of complex interactions among the viral infection, host factors, traditional risk factors, and therapies for HIV. As the HIV population is living longer, largely attributable to combination antiretroviral therapy, there is concern about the effect of the rising prevalence of CHD on morbidity and mortality, as well its effect on health systems around the world. This review will highlight the epidemiological evidence linking HIV infection and CHD. It will also focus on our current understanding of the pathogenesis and factors associated with HIV infection and CHD. In addition, the review will highlight modes of presentation and management strategies for mitigating risk and treatment of HIV-positive patients presenting with CHD.

HIV-1–Associated Atherosclerosis

“…Early in the HIV epidemic, the predominant presentations of HIV-associated CVD were dilated cardiomyopathy, pericardial disease, pulmonary hypertension, HIV-associated malignancies, and OIs. Since the onset of ART, HIV + patients are increasingly at risk for more common cardiovascular complications associated with atherosclerosis, including MI, stroke, and heart failure (2–6). …”

“…In those patients with a high CD4 count, caspase-1 levels decreased immediately, and in patients with a low CD4 count, caspase-1 levels remained elevated after 1 year of HIV infection (88). This process may be independent of the viral envelope (89) and increased by HIV-associated comorbidities (2). Furthermore, NLRP3 inflammasome activation in HIV-infected T cells contributes to the pathogenesis of T cell depletion and activation in HIV + patients (90).…”

“…Atherosclerosis-associated CVD, including myocardial infarction (MI) and stroke, is currently one of the leading causes of mortality among HIV + patients (2–6). There is emerging evidence to indicate that HIV infection and subsequent inflammatory processes in humans accelerate atherogenesis.…”

“…However, the mechanisms for HIV- or SIV-induced atherogenesis remain unclear. HIV-associated atherogenesis may be further complicated by ART, drug abuse, other HIV-associated comorbidities (dyslipidemia, opportunistic infections [OIs], and renal disease), and traditional atherosclerosis risk factors (lifestyle, smoking, and so on) (2). In patients on ART, HIV infection not only mediates immune cell activation and endothelial dysfunction, but also activates an array of cellular pathways, such as inflammasome formation/caspase-1 activation, autophagy, oxidative stress (OS), and endoplasmic reticulum (ER) stress.…”

Dislipidemia and systemic inflammation in HIV-infected patients against combined antiretroviral therapy.

“…На цьому тлі в такого контингенту хворих спостерігається прискорений розвиток атеросклерозу [5,15]. Деякі автори пов'язують таке явище з негативним впливом АРТ, особливо на тлі терапії інгібіторами протеаз, aле єдиної думки з цього приводу наразі не існує [9].…”