Virginia A Triant1, Steven K Grinspoon. 1. Brigham and Women's Hospital and Massachusetts General Hospital Divisions of Infectious Diseases, Boston, Massachusetts, USA.
Abstract
PURPOSE OF REVIEW: Antiretroviral (ARV) therapy has altered the course of HIV disease and dramatically increased the lifespan of HIV-infected individuals. Accumulating evidence, however, suggests that prolonged ARV use contributes to metabolic and cardiovascular changes. Understanding the toxicities of ARV treatment and sequelae of long-term infection is critical. This review will examine recent evidence related to vascular dysfunction and cardiovascular complications in HIV infection. RECENT FINDINGS: Recent studies investigating circulating markers of inflammation, surrogate markers of subclinical atherosclerotic disease, and novel imaging modalities suggest the presence of endothelial dysfunction in HIV-infected patients. In addition, data from several recently updated cohort studies confirm an association between ARV therapy and cardiovascular events. SUMMARY: New data suggest that cardiovascular disease is increased among HIV-infected patients receiving highly active ARV therapy. The mechanisms of increased cardiovascular disease may relate to direct effects of the HIV virus and inflammation on the vasculature or to toxicities from specific ARV therapies, which may increase traditional cardiovascular risk factors. Understanding and modifying these risks and preventing cardiovascular events are critical to the long-term management of the HIV-infected patient.
PURPOSE OF REVIEW: Antiretroviral (ARV) therapy has altered the course of HIV disease and dramatically increased the lifespan of HIV-infected individuals. Accumulating evidence, however, suggests that prolonged ARV use contributes to metabolic and cardiovascular changes. Understanding the toxicities of ARV treatment and sequelae of long-term infection is critical. This review will examine recent evidence related to vascular dysfunction and cardiovascular complications in HIV infection. RECENT FINDINGS: Recent studies investigating circulating markers of inflammation, surrogate markers of subclinical atherosclerotic disease, and novel imaging modalities suggest the presence of endothelial dysfunction in HIV-infectedpatients. In addition, data from several recently updated cohort studies confirm an association between ARV therapy and cardiovascular events. SUMMARY: New data suggest that cardiovascular disease is increased among HIV-infectedpatients receiving highly active ARV therapy. The mechanisms of increased cardiovascular disease may relate to direct effects of the HIV virus and inflammation on the vasculature or to toxicities from specific ARV therapies, which may increase traditional cardiovascular risk factors. Understanding and modifying these risks and preventing cardiovascular events are critical to the long-term management of the HIV-infectedpatient.
Authors: Duy M Dinh; Gretchen E Volpe; Chad Duffalo; Seema Bhalchandra; Albert K Tai; Anne V Kane; Christine A Wanke; Honorine D Ward Journal: J Infect Dis Date: 2014-07-23 Impact factor: 5.226