Journal
CURRENT OPINION IN HIV AND AIDS
Volume 4, Issue 3, Pages 176-182Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/COH.0b013e328329c62f
Keywords
antiretroviral therapy; cardiovascular disease; dyslipidemia; early treatment; endothelial dysfunction; HIV infection; inflammation
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Funding
- NCRR NIH HHS [K12 RR023247-04, K12 RR023247] Funding Source: Medline
- NATIONAL CENTER FOR RESEARCH RESOURCES [K12RR023247] Funding Source: NIH RePORTER
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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 cell counts than currently recommended by guidelines). Recent findings Compared with the general population, HIV-infected patients who receive ART have a greater burden of subclinical and clinical atherosclerotic disease. Findings from a recent international treatment interruption trial (SMART) have 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, upregulation 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-specific and/or drug-specific. Summary Compared with untreated HIV, ART may increase or decrease risk of CVD. Reliable data on the relative risk do not exist. A randomized trial of early ART will provide the best data for assessment of the net risks and benefits of ART use on CVD.
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