Enfermedad cardiovascular en el paciente infectado por el virus de la inmunodeficiencia humana

Abstract

With the introduction of effective antiretroviral therapy (ART), cardiovascular disease has gained importance as a cause of morbidity and mortality in HIV-infected persons. Herein, we will study the risk of cardiovascular disease in HIV-infected persons compared to the non-infected population. The relative contributions regarding the host, HIV infection and antiretroviral therapy will be presented in the light of current knowledge. The absolute risk of developing cardiovascular disease in HIV-infected patients receiving antiretroviral therapy is low. However, this risk is increasing compared to the risk in uninfected persons. This fact is substantially due to a higher prevalence of underlying traditional cardiovascular risk factors that are mostly host-dependent. HIV infection may contribute both directly through immune activation and inflammation and indirectly through immunodeficiency. The type of antiretroviral treatment, also to a lesser degree than HIV infection, may also contribute through its impact on metabolic effects and also because of the changes produced in body fat parameters. Prevention of cardiovascular disease in HIV-infected patients should be standard care. The traditional risk factors should be investigated and aggressively treated whenever possible, since they play a major role in the development of cardiovascular disease. Antiretroviral therapy should be initiated earlier in patients with high cardiovascular risk. From a purely cardiovascular perspective, the benefits of ART, regardless of the drugs used, clearly outweigh any potential risk.