title: HIV and the heart: the impact of antiretroviral therapy: a global perspective.
abstract: From a global perspective, cardiovascular disease (CVD) in human immunodeficiency virus (HIV) may result from cardiac involvement upon presentation of opportunistic infections in the presence of advanced immunosuppression, be a consequence of HIV-induced immune activation or derive from antiretroviral therapy-associated dyslipidaemia and insulin resistance. Indeed, in developed countries with unlimited access to antiretroviral therapy CVD has become one of the major causes of death in HIV. Therefore, cardiovascular risk reduction and lifestyle modifications are essential and careful selection of the antiretroviral drugs according to underlying cardiovascular risk factors of great importance. In developing countries with delayed roll-out of antiretroviral therapy pericardial disease (often related to TB), HIV-associated cardiomyopathy, and HIV-associated pulmonary hypertension are the most common cardiac manifestations in HIV. In Africa, the epicentre of the HIV epidemic, dynamic socio-economic and lifestyle factors characteristic of epidemiological transition appear to have positioned the urban African community at the cross-roads between historically prevalent and 'new' forms of CVD, such as coronary artery disease. In this context, cardiovascular risk assessment of HIV-infected patients will become a critical element of care in developing countries similar to the developed world, and access to antiretroviral therapy with little or no impact on lipid and glucose metabolism of importance to reduce CVD in HIV.
authors.affiliation: Clinical Infectious Diseases Research Initiative, Institute of Infectious Diseases and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Wolfson Pavilion, Room S3.03 Level 3, Anzio Road, Observatory, Cape Town 7925, South Africa.
authors.forename: Friedrich
authors.initials: F
authors.lastname: Thienemann
authors.forename: Karen
authors.initials: K
authors.lastname: Sliwa
authors.forename: Jürgen Kurt
authors.initials: JK
authors.lastname: Rockstroh
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use*; D009202:Cardiomyopathies / Q000821:virology; D060085:Coinfection / Q000150:complications; D003324:Coronary Artery Disease / Q000821:virology; D003925:Diabetic Angiopathies / Q000821:virology; D004347:Drug Interactions; D004359:Drug Therapy, Combination; D014943:Global Health; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D017320:HIV Protease Inhibitors / Q000627:therapeutic use; D006331:Heart Diseases / Q000821:virology*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000821:virology; D007165:Immunosuppression Therapy; D010493:Pericarditis / Q000821:virology; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use; D012307:Risk Factors; D040242:Risk Reduction Behavior; D014376:Tuberculosis / Q000150:complications
chemical_list: D019380:Anti-HIV Agents; D017320:HIV Protease Inhibitors; D018894:Reverse Transcriptase Inhibitors
keywords: ART; Abacavir; Antiretroviral therapy; Cardiomyopathy; Cardiovascular; HIV; Heart; Pericarditis; Protease inhibitors