The consequences of HIV infection and antiretroviral therapy use for cardiovascular disease risk: Shifting paradigms

Jason V. Baker, W. Keith Henry, James D. Neaton

Research output: Contribution to journalReview articlepeer-review

30 Scopus citations

Abstract

Purpose of review: To explore the mechanisms by which HIV infection and antiretroviral therapy (ART) may increase risk for atherosclerotic cardiovascular disease (CVD), with attention to the implications of earlier initiation of ART (i.e. at higher CD4 cell counts than currently recommended by guidelines). Recent findings: Compared with the general population, HIV-infected patients who receive ART have a greater burden of subclinical and clinical atherosclerotic disease. Findings from a recent international treatment interruption trial (SMART) have redirected attention from ART-related drug toxicity toward a better appreciation for the consequences of untreated HIV infection, which may increase CVD risk through inflammation, upregulation of thrombotic pathways, and ultimately early vascular damage and dysfunction. In addition, CVD risk may increase with some ART, and this risk may be class-specific and/or drug-specific. Summary: Compared with untreated HIV, ART may increase or decrease risk of CVD. Reliable data on the relative risk do not exist. A randomized trial of early ART will provide the best data for assessment of the net risks and benefits of ART use on CVD.

Original languageEnglish (US)
Pages (from-to)176-182
Number of pages7
JournalCurrent Opinion in HIV and AIDS
Volume4
Issue number3
DOIs
StatePublished - May 2009

Keywords

  • Antiretroviral therapy
  • Cardiovascular disease
  • Dyslipidemia
  • Early treatment
  • Endothelial dysfunction
  • HIV infection
  • Inflammation

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