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The consequences of HIV infection and antiretroviral therapy use for cardiovascular disease risk: shifting paradigms

Baker, Jason Va,b; Henry, W Keitha,b; Neaton, James Da

Current Opinion in HIV and AIDS: May 2009 - Volume 4 - Issue 3 - p 176–182
doi: 10.1097/COH.0b013e328329c62f
Early treatment: Edited by Sean Emery and Andrew Phillips

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.

aUniversity of Minnesota, USA

bHennepin County Medical Center, Minneapolis, Minnesota, USA

Correspondence to Jason Baker, 701 Park Ave; MC G5, Minneapolis, MN 55415, USA Tel: +1 612 873 2705; fax: +1 612 904 4299; e-mail:

© 2009 Lippincott Williams & Wilkins, Inc.