Antiretroviral treatment

Abstract

Achieving the targets set by UNAIDS for the year 2020 will enable the world to end the AIDS epidemic by 2030. Combination antiretroviral treatment (ART) is key to success of this goal and expanding access to all who need it, an imperative. Human immunodeficiency virus (HIV), ART, and traditional cardiovascular risk factors have all been implicated in the pathogenesis of cardiovascular disease in HIV-infected patients, either separately or collectively. The HIV replication in infected patients without ART is associated with an increase in cardiovascular disease risk, which seems to reduce with ART. Proinflammatory cytokines maintained with HIV infection and associated with endothelial activation leading to a proatherogenic profile appear to improve with ART. Associations between protease inhibitors and increased triglycerides, low-density lipoprotein, and total cholesterol have been demonstrated. Although ART use has been associated with an increased cardiovascular risk in HIV-1-infected patients, the overall mortality benefit of ART seems to outweigh the cardiovascular risk. In the context of ART, traditional risk factors have been shown to be strong predictors of cardiovascular disease. Emphasis should be placed on assessment for and management of traditional risk factors. ART with less cardiovascular toxicity should be selected. Early initiation of ART is now recommended.