Abstract
Despite the combined antiretroviral therapy has improved the length and quality of life of HIV infected patients, the survival of these patients is always decreased compared with the general population. This is the consequence of non-infectious illnesses including cardio vascular diseases. In fact large studies have indicated an increased risk of coronary atherosclerotic disease, myocardial infarction even in HIV patients on cART. In HIV infected patients several factors may contribute to the pathogenesis of cardiovascular problems: life-style, metabolic parameters, genetic predisposition, viral factors, immune activation, chronic inflammation and side effects of antiretroviral therapy. The same factors may also contribute to complicate the clinical management of these patients. Therefore, treatment of these non-infectious illnesses in HIV infected population is an emerging challenge for physicians. The purpose of this review is to focus on the new insights in non AIDS-related cardiovascular diseases in patients with suppressed HIV viremia.
Highlights
Despite the combined antiretroviral therapy has improved the length and quality of life of human immunodeficiency virus (HIV) infected patients, the survival of these patients is always decreased compared with the general population
Does rosuvastatin delay progression This study is a randomised double blind placebo controlled trial Progression of carotid intima media thickof atherosclerosis in people with hiv comparing Rosuvastatin with placebo in HIV positive people ness
In combined antiretroviral therapy (cART) treated HIV-infected individuals with undetectable viremia the level of immune activation is dramatically reduced compared to baseline but rarely goes back to normal levels
Summary
Mean SCD rate: 2.6 per 1000 person-years (95 % CI 1.8–3.8), 4.5-fold higher than expected. To elucidate CVD prevalence in HIV+ outpatients by standardized non-invasive CV screening. Prevalence of CVD: 10.1 % (95 % CI 8.0–12.2 %) Aging HIV-infected patients (≥45 years) exhibited significantly increased rates of CVD, CAD (7.5 vs 1.8 %, p < 0.001). Associated with the prevalence of CVD in multivariate analyses: Age (OR 2.05 xd, 95 % CI 1.64–2.56). The mean MI events per 1000 person-years significantly higher (p < 0.05 for all) for HIV-positive compared with uninfected veterans: Age 40–49 years, 2.0 (1.6–2.4) vs 1.5 (1.3–1.7). After adjusting for Framingham risk factors, comorbidities, and substance use, HIV-positive veterans had an increased risk of inc ident MI compared with uninfected veterans (hazard ratio, 1.48; 95 % CI, 1.27–1.72)
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