Cardiovascular risk associated with antiretroviral therapy in HIV-infected patients

Abstract

Cardiovascular risk factors, including the fat redistribution syndrome, dyslipidaemia, insulin resistance and diabetes mellitus, have been increasingly described in association with new potent protease inhibitor-based antiretroviral therapies in patients with HIV infection. The introduction of highly active antiretroviral therapy (HAART) in clinical practice has altered the natural history of HIV remarkably, leading to a notable extension of life expectancy, and prolonged lipid and glucose metabolism abnormalities are expected to lead to significant effects on the long-term prognosis and outcome of HIV-infected patients. Prediction modelling, surrogate markers and hard cardiovascular end points suggest an increased incidence of cardiovascular diseases in HIV-infected subjects receiving HAART, even though the absolute risk of cardiovascular complications remains low, and must be balanced against the evident virological, immunological and clinical benefits descending from combination antiretroviral therapy. Nevertheless, the assessment of cardiovascular risk should be performed on a regular basis in HIV-positive individuals, especially after initiation or change of antiretroviral treatment. Appropriate lifestyle measures (including smoking cessation, dietary changes and aerobic physical activity) are critical points, and switching HAART may be considered, although maintaining viremic control should be the main goal of therapy. Pharmacological treatment of dyslipidaemia (usually with statins and fibrates) and hyperglycaemia (with insulin-sensitising agents and thiazolidinediones) becomes suitable when lifestyle modifications and switching therapy are ineffective or not applicable.