Coronary heart disease in HIV-infected patients

Abstract

Increased risk of coronary heart disease has emerged as a long-term concern among HIV-infected patients receiving antiretroviral therapy. HIV-infected patients may have modifiable risk factors for heart disease that are associated with HIV itself, antiretroviral therapy, or factors unrelated to HIV. Dyslipidemia, insulin resistance, and diabetes mellitus are often multifactorial in origin. Patients with lipodystrophy frequently have a constellation of metabolic changes that may predispose them to accelerated atherosclerosis. There is also concern about contributions of chronic inflammation and prothrombotic tendencies in the pathogenesis of coronary heart disease in the HIV-infected population. Several epidemiological studies support an increased relative risk of myocardial infarction in HIV-infected patients on highly active antiretroviral therapy. Although absolute risk appears low in the short term, patients may accrue significant risk over time. Clinicians are advised to assess coronary heart disease risk in HIV-infected patients and to intervene to reduce the impact of modifiable risk factors.

HIV Nef Protein Causes Endothelial Dysfunction in Porcine Pulmonary Arteries and Human Pulmonary Artery Endothelial Cells

“…Well documented among these non-infectious complications are those associated with accelerated cardiovascular disease [2]. Autopsy reports were the first to describe the association between coronary artery disease and HIV infection [1].…”

“…HIV primarily attacks the immune system, leading to infection and eventual death from opportunistic infections [2]. However, with better understanding and treatment of the disease, the non-infectious complications of HIV infection are becoming apparent.…”

Infections and Atheromatous Plaque: Current Therapeutic Implications

“…Apart from herpesviridae, other viruses that have been associated with atherosclerosis include hepatitis A, Epstein-Barr, Coxscackie and human immunodeficiency virus (HIV) [89,90]. For the latter the findings are particularly relevant considering the increasing rate of spread of the virus worldwide.…”

Preoperative work-up of the HIV vascular patient—have the goalposts moved?

“…In addition, these drugs exacerbate endothelial dysfunction, with an increase in cardiovascular events with worsening of multiple coronary artery disease risk factors. 3 Does this also apply to the young HIV vascular patient who has never taken antiretrovirals? This question is open to much debate and conjecture in the literature.…”