Cardiovascular risk and risk management in HIV-infected patients.

Patients with HIV infection are at risk of cardiovascular disease from the same factors posing risk in the general population--eg, smoking, dyslipidemia, hypertension, obesity, and diabetes. HIV infection itself and antiretroviral therapy pose additional risk, but available data indicate that the relative rate of myocardial infarction is low and declining in the HIV-infected population. Cardiovascular risk should be addressed before initiation of antiretroviral therapy and frequently during follow-up, and decisions to alter therapy on the basis of adverse changes in metabolic risk factors should be made on an individual basis. Virologic control is the primary goal for HIV-infected persons with cardiovascular risk, and is the primary consideration in determining when to start antiretroviral therapy and when to change regimens. This article summarizes a presentation on cardiovascular risk and risk management in HIV-infected persons made by Oluwatoyin Adeyemi, MD, at an International AIDS Society-USA Continuing Medical Education course in Chicago in May 2007.