title: HIV infection and cardiovascular disease.
abstract: OBJECTIVE
  With the success of antiretroviral therapy (ART), non-human immunodeficiency virus (HIV)-related comorbidities like cardiovascular diseases (CVDs) are of increasing concern. We describe important recent research developments on the epidemiology of CVD in HIV infection, ART-related metabolic changes, and cardioprotective anti-inflammatory mechanisms, and summarize management strategies for CVD risk reduction.
  
  
  RESULTS
  We systematically identified and analysed systematic reviews and most cited literature published in the last 3 years and supplemented findings with selected evidence based on clinical expertise. Among HIV-infected individuals, the prevalence of CVD risk factors and the risk for CVD is higher compared with HIV negatives. Antiretroviral drugs may induce dyslipidaemia, reduce insulin sensitivity, and promote body fat redistribution that additionally contributes to CVD risk. Some antiretroviral drugs may increase risk for CVD events, but the absolute risk increase is moderate and has to be put into perspective with the massive HIV-related benefits. Sustained HIV suppression reduces systemic inflammatory markers and is associated with a moderate reduction in CVD events. Regular CVD risk assessment and counselling to stop smoking must be regularly done in all HIV-infected individuals. Statins are effective for the treatment of dyslipidaemia in HIV infection, but drug interactions with ART need to be considered.
  
  
  CONCLUSIONS
  Human immunodeficiency virus-infected individuals are at increased risk for CVD. Timely initiation of ART with consequent viral suppression is likely to reduce CVD events and to offset potential side effects from ART-induced metabolic changes. Reduction in smoking in HIV-infected individuals is a public health priority.
authors.affiliation: Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, CH-4031 Basel, Switzerland.
authors.forename: Lars G
authors.initials: LG
authors.lastname: Hemkens
authors.affiliation: Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, CH-4031 Basel, Switzerland heiner.bucher@usb.ch.
authors.forename: Heiner C
authors.initials: HC
authors.lastname: Bucher
mesh_terms: D019380:Anti-HIV Agents / Q000009:adverse effects; D002318:Cardiovascular Diseases / Q000821:virology*; D003925:Diabetic Angiopathies / Q000821:virology; D004347:Drug Interactions / Q000502:physiology; D015658:HIV Infections / Q000150:complications*; D039682:HIV-Associated Lipodystrophy Syndrome / Q000150:complications; D006801:Humans; D000960:Hypolipidemic Agents / Q000009:adverse effects; D007333:Insulin Resistance / Q000502:physiology; D011379:Prognosis; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D014657:Vasculitis / Q000821:virology
chemical_list: D019380:Anti-HIV Agents; D000960:Hypolipidemic Agents
keywords: Adverse events; Antiretroviral therapy; Cardiovascular disease; Coronary heart disease; HIV infection