Epidemiology of ischemic heart disease in HIV

Abstract

Purpose of review The purpose of this review is to summarize and synthesize recent data on the risk of ischemic heart disease (IHD) in HIV-infected individuals. Recent findings Recent studies in the field demonstrate an increasing impact of cardiovascular disease (CVD) on morbidity and mortality in HIV relative to AIDS-related diagnoses. Studies continue to support an approximately 1.5 to 2-fold increased risk of IHD conferred by HIV, with specific risk varying by gender and virologic/immunologic status. Risk factors include both traditional CVD risk factors and novel, HIV-specific factors including inflammation and immune activation. Specific antiretroviral therapy (ART) drugs may increase CVD risk, yet the net effect of ART with viral suppression is beneficial with regards to CVD risk. Management of cardiovascular risk and prevention of CVD is complex, because current general population strategies target traditional CVD risk factors only. Extensive investigation is being directed at developing tailored CVD risk prediction algorithms and interventions to reduce CVD risk to HIV. Summary Increased IHD risk is a significant clinical and public health challenge in HIV. The development and application of HIV-specific interventions to manage CVD risk factors and reduce CVD risk will improve the long-term health of this aging population.

Interferon gamma-induced protein 10 (IP-10) and cardiovascular disease in African Americans

“…[3] While immune dysregulation is a common feature of aging, some immunity-related pathways have not been extensively studied in the context of CVD risk. Chronic viral infections such as HIV [4] and hepatitis C (HCV) [5] are associated with increased coronary artery disease risk independent of traditional risk factors. Such chronic viral infection leads to induction of antiviral cytokines, such as type I and type II interferons (IFN), and may promote lowgrade inflammation, immune dysfunction, and hypercoagulability.…”

Coronary artery calcium, HIV and inflammation in Uganda compared with the USA

“…The inflammatory milieu of chronic HIV infection that persists despite antiretroviral therapy (ART)—reflected by increased biomarkers of endothelial and monocyte activation in peripheral blood—may explain the higher ASCVD risk among PLWH 8. Studies of inflammation biomarkers and subclinical vascular disease among PLWH have, however, been mixed,9 with markers of monocyte activation (eg, soluble CD163 (sCD163) and soluble CD14 (sCD14)) showing the most consistent positive associations with the disease 10–12.…”

Coronary artery calcium and intima‐media thickness are associated with level of cytomegalovirus immunoglobulin G in HIV‐infected patients

“…HIV‐infected patients may carry a higher risk for cardiovascular disease (CVD) compared with the general population . Cytomegalovirus (CMV) is suspected to play a part in the development of CVD in HIV‐infected patients, in whom coinfection with CMV is very common .…”