HIV Infection, Antiretroviral Therapy and Cardiovascular Risk

Abstract

Vascular complications in the course of human immunodeficiency virus (HIV) infection are multifactorial and may be caused by the virus itself or by the related opportunistic infections and neoplasms. Highly active antiretroviral therapy (HAART), which dramatically modifies the natural history of HIV disease, causes in a high proportion of patients a metabolic syndrome that includes body fat redistribution, hypercholesterolaemia, hypertriglyceridaemia and insulin resistance. These effects are particularly evident in patients treated with protease inhibitors (PIs). However, studies on the cardiovascular risk among HIV-infected individuals receiving PIs have not shown a consistent association. The pathogenesis of the HAART-associated metabolic syndrome has not been completely elucidated, but there is growing evidence that a synergistic effect between PIs and nucleoside reverse transcriptase inhibitors might play a significant role. All HIV-infected patients candidate to antiretroviral therapy and patients already under treatment should undergo an assessment that includes the evaluation of the cardiovascular risk with the available guidelines.

Power Spectral Analysis of Heart Rate Variability in HIV‐Infected and AIDS Patients

“…Despite recent data showing that HAART can favor endothelial dysfunction and precocious atherogenesis, thus increasing the cardiovascular risk for patients in continuous use of such drugs, several reports have shown a marked improvement in life quality and expectancy, due to a lower incidence of opportunistic infections and myocardial impairment 1,4,6,7,12,13,27–33 . Although our data demonstrate a similar autonomic profile between AIDS patients under HAART and controls, we cannot state that HAART is capable of preventing or treating compromised cardiac autonomic modulation in AIDS patients, since the cardiac autonomic function in these AIDS patients was not assessed prior to the initiation of HAART.…”

“…Cardiovascular involvement concerning the human immunodeficiency virus (HIV) is now well documented 1–3 . The most common clinical manifestations of heart involvement in acquired immunodeficiency syndrome (AIDS), before the introduction of highly active antiretroviral therapy (HAART), were pericarditis, myocarditis, endocarditis, dilated cardiomyopathy, arrhythmias, and ischemic disease 2–7 .…”

“…The most common clinical manifestations of heart involvement in acquired immunodeficiency syndrome (AIDS), before the introduction of highly active antiretroviral therapy (HAART), were pericarditis, myocarditis, endocarditis, dilated cardiomyopathy, arrhythmias, and ischemic disease 2–7 . After the use of HAART regimens, the course of HIV disease was strongly modified and longer survival rates and improved quality of life for HIV‐infected subjects were observed 1,4,8–12 …”

A lectin‐based gold nanoparticle assay for probing glycosylation of glycoproteins

“…The most potent HIV treatment is highly active antiretroviral therapy (HAART). This has increased longevity but has also increased the incidence of various metabolic disorders such as insulin resistance and lipodystrophy, which are associated with type 2 diabetes mellitus and cardiovascular disease respectively [Barbaro, 2002; Florescu and Kotler, 2007; Stein, 2007]. It has emerged that HIV protease inhibitors (HPIs), one of the components of HAART drug therapy, play a critical role in inducing the side effects.…”

HIV-Derived ssRNA Binds to TLR8 to Induce Inflammation-Driven Macrophage Foam Cell Formation

“…Increased risk of atherosclerosis and coronary heart disease (CHD) is a well-recognized clinical problem in HIV-infected patients [1], [2]. HIV survivors in the United States aged 50 and older have increased significantly with reduced AIDS-related morbidity and mortality due to the introduction of combination anti-retroviral therapy (cART) [3] however, these anti-retroviral drugs failed to fully restore health in HIV-infected individuals.…”