Atherosclerosis and Cardiovascular Complications in People Living with HIV: A Focused Review

Overview

Journal Infect Dis Rep

Publisher MDPI

Specialty Infectious Diseases

Date 2024 Sep 23

PMID 39311207

Authors

Michele Salvatore Paterno Raddusa

Andrea Marino

Benedetto Maurizio Celesia

Serena Spampinato

Carmen Giarratana

Emmanuele Venanzi Rullo

Bruno Cacopardo

Giuseppe Nunnari

Affiliations

Soon will be listed here.

Abstract

The intersection of Human Immunodeficiency Virus (HIV) infection and cardiovascular disease (CVD) represents a significant area of concern; advancements in antiretroviral therapy (ART) have notably extended the life expectancy of people living with HIV (PLWH), concurrently elevating the prevalence of chronic conditions such as CVD. This paper explores the multifaceted relationship between HIV infection, ART, and cardiovascular health, focusing on the mechanisms by which HIV and ART contribute to increased cardiovascular risk, including the promotion of endothelial dysfunction, inflammation, immune activation, and metabolic disturbances. We highlight the critical roles of HIV-associated proteins-Tat, Nef, and gp120-in accelerating atherosclerosis through direct and indirect pathways that exacerbate endothelial damage and inflammation. Additionally, we address the persistent challenge of chronic inflammation and immune activation in PLWH, factors that are strongly predictive of non-AIDS-related diseases, including CVD, even in the context of effective viral suppression. The impact of ART on cardiovascular risk is examined, with particular attention to the metabolic implications of specific ART regimens, which can influence lipid profiles and body composition, thereby modifying CVD risk. The therapeutic potential of statins, aspirin, and emerging treatments such as PCSK9 inhibitors in mitigating cardiovascular morbidity and mortality among PLWH is discussed, alongside considerations for their use in conjunction with ART. Our review underscores the necessity for a comprehensive, multidisciplinary approach to cardiovascular care in PLWH, which integrates vigilant cardiovascular risk assessment and management with HIV treatment. As we navigate the evolving landscape of HIV care, the goal remains to optimize treatment outcomes while minimizing cardiovascular risk, ensuring that the gains in longevity afforded by ART translate into improved overall health and quality of life for PLWH.

Citing Articles

Critical Care Pharmacology of Antiretroviral Therapy in Adults.

La Via L, Marino A, Cuttone G, Nunnari G, Deana C, Tesauro M Eur J Drug Metab Pharmacokinet. 2025; 50(2):105-118.

PMID: 39937350 PMC: 11882694. DOI: 10.1007/s13318-025-00934-7.

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