Abstract
Life expectancy in HIV-infected individuals has been greatly enhanced through immunologic restoration and virologic suppression resulting from antiretroviral therapy. Current clinical HIV care in Western countries focuses on treatment of drug toxicities and prevention of comorbidities. These non-AIDS HIV-related comorbidities, such as cardiovascular disease, occur even in individuals with virologic suppression and manifest at an earlier age than when normally presenting in the general population. While traditional risk factors are present in many HIV-infected individuals who develop cardiovascular disease, the additional roles of HIV-related chronic inflammation and immune activation as well as chronic HIV viremia may be significant. This review provides current evidence for the contributions of the virus, in terms of both chronic viremia and its contribution via chronic low-level inflammation, immune activation, premature immune senescence and dyslipidemia, to the pathogenesis of HIV-related cardiovascular disease, and balances this against the propensity of specific antiretroviral therapies to cause cardiovascular disease, in particular through altered cholesterol metabolism.
Financial & competing interests disclosure
Anna Maisa, Clare Westhorpe, Anthony Jaworowski, Anna C Hearps and Suzanne M Crowe are supported by the Australian Centre for Hepatitis and HIV Virology Research. Anna Maisa is supported by a fellowship within the Postdoc Programme of the German Academic Exchange Service (DAAD). Suzanne Crowe is an NHMRC Principal Research Fellow. Julian H Elliott is on advisory boards for Tibotec and ViiV Healthcare. Jennifer Hoy is on advisory boards of Bristol-Myers-Squibb, Gilead, Tibotec, Merck, Sharp & Dohme and ViiV. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.
No writing assistance was utilized in the production of this manuscript.