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Cardiovascular Disease in the Setting of Human Immunodeficiency Virus Infection.

ABSTRACT: BACKGROUND:Since the introduction of Antiretroviral Therapy (ART), the life expectancy and health quality for patients infected with Human Immunodeficiency Virus (HIV) have significantly improved. Nevertheless, as a result of not only the deleterious effects of the virus itself and prolonged ART, but also the effects of aging, cardiovascular diseases have emerged as one of the most common causes of death among these patients. OBJECTIVE:The purpose of this review is to explore the new insights on the spectrum of Cardiovascular Disease (CVD) in HIV infection, with emphasis on the factors that contribute to the atherosclerotic process and its role in the development of acute coronary syndrome in the setting of infection. METHODS:A literature search using PubMed, ScienceDirect and Web of Science was performed. Articles up to Mar, 2017, were selected for inclusion. The search was conducted using MeSH terms, with the following key terms: [human immunodeficiency virus AND (cardiovascular disease OR coronary heart disease) AND (antiretroviral therapy AND (cardiovascular disease OR coronary heart disease))]. RESULTS:Clinical cardiovascular disease tends to appear approximately 10 years before in infected individuals, when compared to the general population. The pathogenesis behind the cardiovascular, HIV-associated complications is complex and multifactorial, involving traditional CVD risk factors, as well as factors associated with the virus itself - immune activation and chronic inflammation - and the metabolic disorders related to ART regimens. CONCLUSION:Determining the cardiovascular risk among HIV-infected patients, as well as targeting and treating conditions that predispose to CVD, are now emerging concerns among physicians.

SUBMITTER: Pinto DSM

PROVIDER: S-EPMC5872259 | biostudies-literature | 2018 Mar

REPOSITORIES: biostudies-literature

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Cardiovascular Disease in the Setting of Human Immunodeficiency Virus Infection.

Pinto Daniela Sofia Martins DSM da Silva Manuel Joaquim Lopes Vaz MJLV

Current cardiology reviews 20180301 1

<h4>Background</h4>Since the introduction of Antiretroviral Therapy (ART), the life expectancy and health quality for patients infected with Human Immunodeficiency Virus (HIV) have significantly improved. Nevertheless, as a result of not only the deleterious effects of the virus itself and prolonged ART, but also the effects of aging, cardiovascular diseases have emerged as one of the most common causes of death among these patients.<h4>Objective</h4>The purpose of this review is to explore the ...[more]

PMID: 29189172

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Project description:BACKGROUND:The effect of human immunodeficiency virus (HIV) on the development of peripheral artery disease (PAD) remains unclear. We investigated whether HIV infection is associated with an increased risk of PAD after adjustment for traditional atherosclerotic risk factors in a large cohort of HIV-infected (HIV+) and demographically similar HIV-uninfected veterans. METHODS:We studied participants in the Veterans Aging Cohort Study from April 1, 2003 through December 31, 2014. We excluded participants with known prior PAD or prevalent cardiovascular disease (myocardial infarction, stroke, coronary heart disease, and congestive heart failure) and analyzed the effect of HIV status on the risk of incident PAD events after adjusting for demographics, PAD risk factors, substance use, CD4 cell count, HIV-1 ribonucleic acid, and antiretroviral therapy. The primary outcome is incident peripheral artery disease events. Secondary outcomes include mortality and amputation in subjects with incident PAD events by HIV infection status, viral load, and CD4 count. RESULTS:Among 91 953 participants, over a median follow up of 9.0 years, there were 7708 incident PAD events. Rates of incident PAD events per 1000 person-years were higher among HIV+ (11.9; 95% confidence interval [CI], 11.5-12.4) than uninfected veterans (9.9; 95% CI, 9.6-10.1). After adjustment for demographics, PAD risk factors, and other covariates, HIV+ veterans had an increased risk of incident PAD events compared with uninfected veterans (hazard ratio [HR], 1.19; 95% CI, 1.13-1.25). This risk was highest among those with time-updated HIV viral load >500 copies/mL (HR, 1.51; 95% CI, 1.38-1.65) and CD4 cell counts <200 cells/mm3 (HR, 1.91; 95% CI, 1.71-2.13). In contrast, HIV+ veterans with time updated CD4 cell count ?500 cells/mm3 had no increased risk of PAD (HR, 1.03; 95% CI, 0.96-1.11). Mortality rates after incident PAD events are high regardless of HIV status. HIV infection did not affect rates of amputation after incident PAD events. CONCLUSIONS:Infection with HIV is associated with a 19% increased risk of PAD beyond that explained by traditional atherosclerotic risk factors. However, for those with sustained CD4 cell counts <200 cells/mm3, the risk of incident PAD events is nearly 2-fold higher whereas for those with sustained CD4 cell counts ?500 cells/mm3 there is no excess risk of incident PAD events compared with uninfected people.

Dataset Information

Cardiovascular Disease in the Setting of Human Immunodeficiency Virus Infection.

Publications

Cardiovascular Disease in the Setting of Human Immunodeficiency Virus Infection.

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