The spectrum of atherosclerotic coronary artery disease in HIV patients.
The incidence of HIV is on the rise. With the advent of antiretroviral therapy, the average life expectancy of HIV patients has increased by several decades, but the increasing life expectancy has shifted the spectrum of HIV-associated morbidity and mortality away from opportunistic infections and toward chronic medical conditions. In fact, coronary artery disease has become the leading cause of mortality in patients with HIV. The pathophysiology of atherosclerosis in patients with HIV is very complex, including direct endothelial damage from viremia, a heightened overall state of inflammation from immune activation, higher prevalence and contribution from traditional atherosclerotic risk factors, and direct effects from antiretroviral therapy itself. This review focuses on the patterns, predictors, and pathophysiology of atherosclerotic disease in patients with HIV. In addition, the risks and benefits of evidence-based highly active antiretroviral therapy are critically evaluated.
Hakeem
Abdul
A
Department of Medicine, University of Cincinnati, OH 45206, USA. ahakeem@gmail.com
Bhatti
Sabha
S
Cilingiroglu
Mehmet
M
D044966:Anti-Retroviral Agents / Q000009:adverse effects; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects; D050197:Atherosclerosis / Q000453:epidemiology / Q000209:etiology*; D003324:Coronary Artery Disease / Q000453:epidemiology / Q000209:etiology*; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000401:mortality; D006801:Humans; D015994:Incidence; D015995:Prevalence; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology
D044966:Anti-Retroviral Agents