HIV-ASSOCIATED CO-MORBIDITIES: Edited by Morris Schambelan and Todd T. BrownMechanisms and primary prevention of atherosclerotic cardiovascular disease among people living with HIVDurstenfeld, Matthew S.a,b; Hsue, Priscilla Y.a,bAuthor Information aDivision of Cardiology, UCSF at Zuckerberg San Francisco General Hospital bDepartment of Medicine, University of California, San Francisco, California, USA Correspondence to Matthew S. Durstenfeld, MD, Division of Cardiology, UCSF, Zuckerberg San Francisco General Hospital, 1001 Potrero Avenue, 5G4, San Francisco, CA 94110, USA. Tel: +1 628 206 5461; e-mail: [email protected] Current Opinion in HIV and AIDS: May 2021 - Volume 16 - Issue 3 - p 177-185 doi: 10.1097/COH.0000000000000681 Buy Metrics Abstract Purpose of review To highlight mechanisms of elevated risk of atherosclerotic cardiovascular disease (ASCVD) among people living with HIV (PLWH), discuss therapeutic strategies, and opportunities for primary prevention. Recent findings HIV-associated ASCVD risk is likely multifactorial and due to HIV-specific factors and traditional risk factors even in the setting of treated and suppressed HIV disease. Although a growing body of evidence suggests that inflammation and immune activation are key drivers of atherogenesis, therapies designed to lower inflammation including colchicine and low-dose methotrexate have not improved secondary cardiovascular endpoints among PLWH. Statins continue to be the mainstay of management of hyperlipidemia in HIV, but the impact of newer lipid therapies including proprotein convertase subtilisin/kexin type 9 inhibitors on ASCVD risk among PLWH is under investigation. Aside from the factors mentioned above, healthcare disparities are particularly prominent among PLWH and thus likely contribute to increased ASCVD risk. Summary Our understanding of mechanisms of elevated ASCVD risk in HIV continues to evolve, and the optimal treatment for CVD in HIV aside from targeting traditional risk factors remains unknown. Future studies including novel therapies to lower inflammation, control of risk factors, and implementation science are needed to ascertain optimal ways to treat and prevent ASCVD among PLWH. Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.