Imaging to End Points: Cardiovascular Disease Risk Assessment in HIV.

Abstract

The remarkable evolution of the HIV epidemic from a near uniformly fatal condition to a chronic viral infection now managed for many patients with 1 pill once a day marks one of the great accomplishments of medicine in recent decades. Life expectancy estimates for people living with HIV with access to antiretroviral therapy are beginning to approach life expectancy estimates of the general population.1 However, not long after the widespread use of combination antiretroviral therapy for the treatment of HIV, clinicians began to recognize undesirable effects of HIV therapy such as dyslipidemia and alterations in body fat distribution. These observations stimulated considerable attention from HIV providers and researchers to identify and understand cardiovascular disease (CVD) risk associated with HIV and its therapy. See Article by Janjua et al Early large cohort studies designed to evaluate CVD outcomes in the context of HIV demonstrated an increased risk of myocardial infarction in association with increasing years of antiretroviral therapy exposure, and observational patient registries showed that rates of myocardial infarction in people living with HIV are increased compared with uninfected contemporaries.2,3 Subsequent cohort studies have consistently validated these observations, identifying ≈1.5-fold higher risk of acute myocardial infarction in people living with HIV compared with uninfected controls. In these studies, the enhanced risk of CVD associated with a diagnosis of HIV was found to be independent of traditional CVD risk factors, which are often enriched in HIV-infected populations.4,5 Considerable efforts are underway to optimize CVD risk assessment and to characterize the unique contribution that HIV and immune activation play in the pathophysiology of CVD in people living with HIV. Recent estimates for the aging characteristics of the HIV-infected population suggest that by 2030 as many as 73% of people living with HIV will be over the …