Purpose of Review
To explore the mechanisms by which HIV infection and antiretroviral therapy (ART) may increase risk for atherosclerotic cardiovascular disease (CVD), with attention to the implications of earlier initiation of ART (i.e. at higher CD4 counts than currently recommended by guidelines).
Compared to the general population, HIV-infected patients receiving ART have a greater burden of subclinical and clinical atherosclerotic disease. Findings from a recent international treatment interruption trial (SMART) has redirected attention from ART-related drug toxicity toward a better appreciation for the consequences of untreated HIV infection, which may increase CVD risk through inflammation, up-regulation of thrombotic pathways, and ultimately early vascular damage and dysfunction. In addition, CVD risk may increase with some ART, and this risk may be class- and/or drug-specific.
Compared to untreated HIV, ART may increase or decrease risk of CVD. Reliable data on the relative risk does not exist. A randomized trial of early ART will provide the best data for assessing the net risks and benefits of ART use on CVD.
Keywords: HIV infection, Antiretroviral therapy, Cardiovascular Disease, Endothelial Dysfunction, Inflammation, Dyslipidemia, Early Treatment