title: Risk of coronary heart disease in patients with HIV infection.
abstract: The lives of individuals infected with HIV who have access to combination antiretroviral therapy (cART) are substantially prolonged, which increases the risk of developing non-AIDS comorbidities, including coronary heart disease (CHD). In Europe and the USA, individuals with HIV infection have a ∼1.5-fold increased risk of myocardial infarction relative to uninfected individuals. In Africa, the relative risk of myocardial infarction is unknown, but broadened access to life-extending cART suggests that rates of CHD will rise in this and other resource-constrained regions. Atherogenesis in HIV is affected by complex interactions between traditional and immune risk factors. cART has varied, regimen-specific effects on metabolic risk factors. Overall, cART seems to lessen proatherogenic immune activation, but does not eliminate it even in patients in whom viraemia is suppressed. Current strategies to decrease the risk of CHD in individuals infected with HIV include early initiation of cART regimens with the fewest metabolic adverse effects, and careful management of traditional CHD risk factors throughout treatment. Future strategies to prevent CHD in patients with HIV infection might involve the use of HIV-tailored CHD risk-prediction paradigms and the administration of therapies alongside cART that will further decrease proatherogenic HIV-specific immune activation.
authors.affiliation: Program in Nutritional Metabolism, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street 5-LON 211, Boston, MA 02114, USA.
authors.forename: Markella V
authors.initials: MV
authors.lastname: Zanni
authors.affiliation: Department of Global Health, Academic Medical Center and Amsterdam Institute for Global Health and Development, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands.
authors.forename: Judith
authors.initials: J
authors.lastname: Schouten
authors.affiliation: Program in Nutritional Metabolism, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street 5-LON 211, Boston, MA 02114, USA.
authors.forename: Steven K
authors.initials: SK
authors.lastname: Grinspoon
authors.affiliation: Department of Global Health, Academic Medical Center and Amsterdam Institute for Global Health and Development, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands.
authors.forename: Peter
authors.initials: P
authors.lastname: Reiss
mesh_terms: D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects / Q000379:methods*; D003327:Coronary Disease / Q000453:epidemiology* / Q000276:immunology; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000276:immunology; D006801:Humans; D009203:Myocardial Infarction / Q000453:epidemiology*; D012307:Risk Factors