title: Atherosclerotic Cardiovascular Disease and Anti-Retroviral Therapy.
abstract: In the current era of available therapy for human immunodeficiency virus (HIV), life expectancy for persons living with HIV (PLWH) nears that of the general population. Atherosclerotic cardiovascular disease (ASCVD) has become a particular burden for PLWH and society at large. PLWH have historically been shown to have an excess of cardiovascular risk and subsequent events when compared to the general population. Potential explanations include the increased prevalence of traditional risk factors, direct inflammatory and immunological effects from the HIV virus itself, and metabolic adverse effects of anti-retroviral therapy (ART). Over the past few years, there has been building evidence that chronic inflammation and immune activation independent of virologic suppression contribute significantly to excess ASCVD risk. Although independent agents and combination therapies have varying metabolic effects, the evidence from major randomized controlled trials (RCTs) supports the benefits of early initiation of ART. In this review, we will discuss the epidemiology of ASCVD in HIV-infected patients compared with the general population, give an overview of potential pathogenesis of high-risk plaque in HIV-infected patients, discuss different metabolic effects of individual anti-retrovirals, and discuss the limitations in current screening models for assessing cardiovascular disease (CVD) risk and future directions for treatment.
authors: Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1090, New York, NY, 10029, USA.
authors: Emma
authors: E
authors: Kaplan-Lewis
authors: Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1090, New York, NY, 10029, USA.
authors: Judith A
authors: JA
authors: Aberg
authors: Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1090, New York, NY, 10029, USA. Mikyung.Lee@mssm.edu.
authors: Mikyung
authors: M
authors: Lee
mesh_terms: D019380:Anti-HIV Agents / Q000009:adverse effects*; D050197:Atherosclerosis / Q000150:complications* / Q000188:drug therapy / Q000276:immunology / Q000503:physiopathology; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy* / Q000276:immunology / Q000503:physiopathology; D006801:Humans; D007249:Inflammation / Q000139:chemically induced* / Q000276:immunology; D008213:Lymphocyte Activation / Q000187:drug effects / Q000276:immunology; D008403:Mass Screening; D018570:Risk Assessment; D012307:Risk Factors; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents
keywords: Anti-retroviral therapy; Atherosclerotic cardiovascular disease; CVD risk; Cardiovascular risk; HIV; PLWH; Persons living with HIV; Randomized controlled trials