HIV infection and coronary heart disease: mechanisms and management

Antiretroviral therapy has largely transformed HIV infection into a chronic disease condition. As such, physicians and other providers caring for individuals living with HIV infection need to be aware of the potential cardiovascular complications of HIV infection and the nuances of how HIV infection increases the risk of cardiovascular diseases, including acute myocardial infarction, stroke, peripheral artery disease, heart failure and sudden cardiac death, as well as how to select available therapies to reduce this risk. In this Review, we discuss the epidemiology and clinical features of cardiovascular disease, with a focus on coronary heart disease, in the setting of HIV infection, which includes a substantially increased risk of myocardial infarction even when the HIV infection is well controlled. We also discuss the mechanisms underlying HIV-associated atherosclerotic cardiovascular disease, such as the high rates of traditional cardiovascular risk factors in patients with HIV infection and HIV-related factors, including the use of antiretroviral therapy and chronic inflammation in the setting of effectively treated HIV infection. Finally, we highlight available therapeutic strategies, as well as approaches under investigation, to reduce the risk of cardiovascular disease and lower inflammation in patients with HIV infection. Antiretroviral therapy has transformed HIV infection into a chronic disease, and cardiovascular diseases are an important health concern in this setting. This Review discusses the clinical features of cardiovascular disease in patients with HIV infection, including the mechanisms underlying HIV-associated atherosclerosis and approaches to reduce the cardiovascular risk. Key points As improvements to antiretroviral therapies have led to better control of HIV infection (although not cured it), individuals with HIV infection are now ageing, and cardiovascular disease is an important health concern in this patient population. Traditional risk factors including dyslipidaemia, hypertension, cigarette smoking, diabetes mellitus and metabolic syndrome are common among people with HIV infection and increase the risk of cardiovascular disease. In addition to traditional risk factors, characteristics related to HIV infection, including low CD4 + T cell count, nadir CD4 + T cell count and viral detectability, and some antiretroviral therapies are independently associated with increased risk of cardiovascular disease. In the setting of treate