The consequences of HIV infection and antiretroviral therapy use for cardiovascular disease risk: shifting paradigms.
OBJECTIVE
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).


RESULTS
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.


CONCLUSIONS
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.
Baker
Jason V
JV
University of Minnesota, Hennepin County Medical Center, Minneapolis, Minnesota, USA. baker459@umn.edu
Henry
W Keith
WK
Neaton
James D
JD
D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D002318:Cardiovascular Diseases / Q000150:complications* / Q000209:etiology*; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D013997:Time Factors; D016896:Treatment Outcome
D019380:Anti-HIV Agents