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Current HIV/AIDS Reports

, Volume 10, Issue 3, pp 199–206 | Cite as

Cardiovascular Disease and HIV Infection

  • Virginia A. TriantEmail author
Metabolic Complications and Comorbidity (JM Kilby, Section Editor)

Abstract

The emergence of chronic disease complications in controlled HIV disease has changed the landscape of HIV clinical care. HIV infection confers an increased cardiovascular disease risk, which is thought to be due to a complex interplay of mechanistic factors. While traditional cardiovascular risk factors likely play a role, recent evidence suggests that HIV-associated inflammation and immune activation are important mediators of cardiovascular risk. It is unclear whether established preventative interventions for the general population are applicable to HIV-infected patients, and the need to translate mechanistic knowledge into HIV-specific clinical interventions represents an important priority. Developing strategies to prevent cardiovascular disease in HIV-infected individuals calls for a multidisciplinary approach and represents an opportunity to exert a major public health impact in an at-risk population.

Keywords

HIV Cardiovascular Coronary Myocardial infarction Risk factors 

Notes

Compliance with Ethics Guidelines

Conflict of Interest

Virginia A. Triant declares that she has no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Currier JS et al. Coronary heart disease in HIV-infected individuals. J Acquir Immune Defic Syndr. 2003;33:506–12.PubMedCrossRefGoogle Scholar
  2. 2.
    Durand M et al. Association between HIV infection, antiretroviral therapy, and risk of acute myocardial infarction: a cohort and nested case–control study using Quebec's public health insurance database. J Acquir Immune Defic Syndr. 2011;57:245–53.PubMedCrossRefGoogle Scholar
  3. 3.
    Klein D et al. Do protease inhibitors increase the risk for coronary heart disease in patients with HIV-1 infection? J Acquir Immune Defic Syndr. 2002;30:471–7.PubMedCrossRefGoogle Scholar
  4. 4.
    Lang S et al. Increased risk of myocardial infarction in HIV-infected patients in France, relative to the general population. AIDS. 2010;24:1228–30.PubMedCrossRefGoogle Scholar
  5. 5.
    Obel N et al. Ischemic heart disease in HIV-infected and HIV-uninfected individuals: a population-based cohort study. Clin Infect Dis. 2007;44:1625–31.PubMedCrossRefGoogle Scholar
  6. 6.
    Triant VA et al. Increased acute myocardial infarction rates and cardiovascular risk factors among patients with human immunodeficiency virus disease. J Clin Endocrinol Metab. 2007;92:2506–12.PubMedCrossRefGoogle Scholar
  7. 7.
    • Freiberg MS et al. HIV infection and the risk of acute myocardial infarction. JAMA. 2013;173:614–22. In this study of a large VA HIV cohort, HIV infection increased risk of myocardial infarction 1.5-fold, adjusting for sociodemographic and cardiovascular confounders. This study corroborates previous data indicating an increased relative risk of myocardial infarction for HIV-infected patients.Google Scholar
  8. 8.
    Islam FM et al. Relative risk of cardiovascular disease among people living with HIV: a systematic review and meta-analysis. HIV Med. 2012;13:453–68.PubMedGoogle Scholar
  9. 9.
    Althoff K, Gange S. A critical epidemiological review of cardiovascular disease risk in HIV-infected adults: the importance of the HIV-uninfected comparison group, confounding, and competing risks. HIV Med. 2013;14:191–2.PubMedCrossRefGoogle Scholar
  10. 10.
    Hsue PY et al. Clinical features of acute coronary syndromes in patients with human immunodeficiency virus infection. Circulation. 2004;109:316–9.PubMedCrossRefGoogle Scholar
  11. 11.
    Knudsen A et al. Angiographic features and cardiovascular risk factors in human immunodeficiency virus-infected patients with first-time acute coronary syndrome. Am J Cardiol. 2013;111:63–7.PubMedCrossRefGoogle Scholar
  12. 12.
    Perello R et al. Clinical presentation of acute coronary syndrome in HIV infected adults: a retrospective analysis of a prospectively collected cohort. Eur J Int Med. 2011;22:485–8.CrossRefGoogle Scholar
  13. 13.
    Pearce D et al. Comparison of in-hospital mortality from acute myocardial infarction in HIV sero-positive vs sero-negative individuals. Am J Cardiol. 2012;110:1078–84.PubMedCrossRefGoogle Scholar
  14. 14.
    Lorgis L et al. Outcomes after acute myocardial infarction in HIV-infected patients: analysis of data from a French nationwide hospital medical information database. Circulation. 2013;127:1767–74.PubMedCrossRefGoogle Scholar
  15. 15.
    D'Ascenzo F et al. Acute coronary syndromes in human immunodeficiency virus patients: a meta-analysis investigating adverse event rates and the role of antiretroviral therapy. Eur Heart J. 2012;33:875–80.PubMedCrossRefGoogle Scholar
  16. 16.
    Rasmussen LD et al. Risk of cerebrovascular events in persons with and without HIV: a Danish nationwide population-based cohort study. AIDS. 2011;25:1637–46.PubMedCrossRefGoogle Scholar
  17. 17.
    Chow FC et al. Comparison of ischemic stroke incidence in HIV-infected and non-HIV-infected patients in a US health care system. J Acquir Immune Defic Syndr. 2012;60:351–8.PubMedCrossRefGoogle Scholar
  18. 18.
    Ovbiagele B, Nath A. Increasing incidence of ischemic stroke in patients with HIV infection. Neurology. 2011;76:444–50.PubMedCrossRefGoogle Scholar
  19. 19.
    • Tseng ZH et al. Sudden cardiac death in patients with human immunodeficiency virus infection. J Am Coll Cardiol. 2012;59:1891–6. HIV-infected patients at a public San Francisco clinic had a striking 4.5-fold increased risk of sudden cardiac death, when compared with the anticipated city-wide rate. As the first study to show such an increase, it highlights the significant impact of CVD-related mortality in HIV groups and underscores the need for prevention strategies.PubMedCrossRefGoogle Scholar
  20. 20.
    Ye Y et al. HIV infection: an independent risk factor of peripheral arterial disease. J Acquir Immune Defic Syndr. 2010;53:276–8.PubMedCrossRefGoogle Scholar
  21. 21.
    Butt A et al. Risk of heart failure with human immunodeficiency virus in the absence of prior diagnosis of coronary heart disease. Arch Intern Med. 2011;171:737–43.PubMedCrossRefGoogle Scholar
  22. 22.
    Hsu JC, et al. Atrial fibrillation and atrial flutter in HIV-infected persons: incidence, risk factors, and association with markers of HIV disease severity. J Am Coll Cardiol. 2013.Google Scholar
  23. 23.
    Meier A et al. Sex differences in the Toll-like receptor-mediated response of plasmacytoid dendritic cells to HIV-1. Nat Med. 2009;15:955–9.PubMedCrossRefGoogle Scholar
  24. 24.
    Bedimo R et al. Hepatitis C virus coinfection and the risk of cardiovascular disease among HIV-infected patients. HIV Med. 2010;11:462–8.PubMedGoogle Scholar
  25. 25.
    Freiberg MS et al. The risk of incident coronary heart disease among veterans with and without HIV and hepatitis C. Circ Cardiovasc Qual Outcomes. 2011;4:425–32.PubMedCrossRefGoogle Scholar
  26. 26.
    Weber R et al. HBV or HCV coinfections and risk of myocardial infarction in HIV-infected individuals: the D:A:D Cohort Study. Antivir Ther. 2010;15:1077–86.PubMedCrossRefGoogle Scholar
  27. 27.
    Sacre K et al. A role for cytomegalovirus-specific CD4 + CX3CR1+ T cells and cytomegalovirus-induced T-cell immunopathology in HIV-associated atherosclerosis. AIDS. 2012;26:805–14.PubMedCrossRefGoogle Scholar
  28. 28.
    Parrinello CM et al. Cytomegalovirus immunoglobulin G antibody is associated with subclinical carotid artery disease among HIV-infected women. J Infect Dis. 2012;205:1788–96.PubMedCrossRefGoogle Scholar
  29. 29.
    Hechter RC et al. Herpes simplex virus type 2 (HSV-2) as a coronary atherosclerosis risk factor in HIV-infected men: multicenter AIDS cohort study. Atherosclerosis. 2012;223:433–6.PubMedCrossRefGoogle Scholar
  30. 30.
    Campbell LJ et al. Renal impairment is associated with coronary heart disease in HIV-positive men. HIV Clinical Trials. 2012;13:343–9.PubMedCrossRefGoogle Scholar
  31. 31.
    Lai H et al. Vitamin D deficiency is associated with silent coronary artery disease in cardiovascularly asymptomatic African Americans with HIV infection. Clin Infect Dis. 2012;54:1747–55.PubMedCrossRefGoogle Scholar
  32. 32.
    Lang J, et al. Serum albumin and short-term risk for mortality and cardiovascular disease among HIV-infected veterans. AIDS. 2013.Google Scholar
  33. 33.
    Lichtenstein KA et al. Low CD4+ T cell count is a risk factor for cardiovascular disease events in the HIV outpatient study. Clin Infect Dis. 2010;51:435–47.PubMedCrossRefGoogle Scholar
  34. 34.
    Triant VA et al. Association of immunologic and virologic factors with myocardial infarction rates in a US healthcare system. J Acquir Immune Defic Syndr. 2010;55:615–9.PubMedCrossRefGoogle Scholar
  35. 35.
    Lang S et al. HIV replication and immune status are independent predictors of the risk of myocardial infarction in HIV-infected individuals. Clin Infect Dis. 2012;55:600–7.PubMedCrossRefGoogle Scholar
  36. 36.
    Ho JE et al. The association of CD4+ T-cell counts and cardiovascular risk in treated HIV disease. AIDS. 2012;26:1115–20.PubMedCrossRefGoogle Scholar
  37. 37.
    Duarte H et al. Non-calcified coronary plaque volume inversely related to CD4(+) T-cell count in HIV infection. Antivir Ther. 2012;17:763–7.PubMedCrossRefGoogle Scholar
  38. 38.
    van Lelyveld SF et al. Long-term complications in patients with poor immunological recovery despite virological successful HAART in Dutch ATHENA cohort. AIDS. 2012;26:465–74.PubMedCrossRefGoogle Scholar
  39. 39.
    Helleberg M, et al. CD4 decline is associated with increased risk of cardiovascular disease, cancer and death in virally suppressed HIV patients. Clin Infect Dis. 2013.Google Scholar
  40. 40.
    Zhang S et al. Episodes of HIV viremia and the risk of non-AIDS diseases in patients on suppressive antiretroviral therapy. J Acquir Immune Defic Syndr. 2012;60:265–72.PubMedCrossRefGoogle Scholar
  41. 41.
    Bucher HC et al. Small dense lipoproteins, apolipoprotein B, and risk of coronary events in HIV-infected patients on antiretroviral therapy: the Swiss HIV Cohort Study. J Acquir Immune Defic Syndr. 2012;60:135–42.PubMedCrossRefGoogle Scholar
  42. 42.
    Lucero C, et al. Rate and predictors of non-AIDS events in a cohort of HIV-infected patients with a CD4 T cell count above 500 cells/mm3. AIDS Research and Human Retroviruses. 2013.Google Scholar
  43. 43.
    Grinspoon S, Carr A. Cardiovascular risk and body-fat abnormalities in HIV-infected adults. N Engl J Med. 2005;352:48–62.PubMedCrossRefGoogle Scholar
  44. 44.
    Rotger M, et al. Contribution of genetic background, traditional risk factors and HIV-related factors to coronary artery disease events in HIV-positive persons. Clin Infect Dis. 2013.Google Scholar
  45. 45.
    Friis-Moller N et al. Class of antiretroviral drugs and the risk of myocardial infarction. N Engl J Med. 2007;356:1723–35.PubMedCrossRefGoogle Scholar
  46. 46.
    Worm SW et al. Risk of myocardial infarction in patients with HIV infection exposed to specific individual antiretroviral drugs from the 3 major drug classes: the data collection on adverse events of anti-HIV drugs (D:A:D) study. J Infect Dis. 2010;201:318–30.PubMedCrossRefGoogle Scholar
  47. 47.
    Lang S et al. Impact of individual antiretroviral drugs on the risk of myocardial infarction in Human Immunodeficiency Virus-infected patients: a case–control study nested within the French hospital database on HIV ANRS cohort CO4. Arch Intern Med. 2010;170:1228–38.PubMedCrossRefGoogle Scholar
  48. 48.
    Monforte A et al. Atazanavir is not associated with an increased risk of cardio or cerebrovascular disease events. AIDS. 2013;27:407–15.PubMedCrossRefGoogle Scholar
  49. 49.
    Bavinger C et al. Risk of cardiovascular disease from antiretroviral therapy for HIV: a systematic review. PLoS One. 2013;8:e59551.PubMedCrossRefGoogle Scholar
  50. 50.
    Cruciani M et al. Abacavir use and cardiovascular disease events: a meta-analysis of published and unpublished data. AIDS. 2011;25:1993–2004.PubMedCrossRefGoogle Scholar
  51. 51.
    Ding X et al. No association of abacavir use with myocardial infarction: findings of an FDA meta-analysis. J Acquir Immune Defic Syndr. 2012;61:441–7.PubMedCrossRefGoogle Scholar
  52. 52.
    El-Sadr WM et al. CD4+ count-guided interruption of antiretroviral treatment. N Engl J Med. 2006;355:2283–96.PubMedCrossRefGoogle Scholar
  53. 53.
    Zanni MV, Grinspoon SK. HIV-specific immune dysregulation and atherosclerosis. Curr HIV/AIDS Rpts. 2012;9:200–5.CrossRefGoogle Scholar
  54. 54.
    Lo J, Plutzky J. The biology of atherosclerosis: general paradigms and distinct pathogenic mechanisms among HIV-infected patients. J Infect Dis. 2012;205 Suppl 3:S368–74.PubMedCrossRefGoogle Scholar
  55. 55.
    Deeks SG. HIV infection, inflammation, immunosenescence, and aging. Annu Rev Med. 2011;62:141–55.PubMedCrossRefGoogle Scholar
  56. 56.
    Hunt PW. HIV and inflammation: mechanisms and consequences. Curr HIV/AIDS Rpts. 2012;9:139–47.CrossRefGoogle Scholar
  57. 57.
    Armah KA et al. HIV status, burden of comorbid disease, and biomarkers of inflammation, altered coagulation, and monocyte activation. Clin Infect Dis. 2012;55:126–36.PubMedCrossRefGoogle Scholar
  58. 58.
    Hsue PY, et al. Carotid intima-media thickness progression in HIV-infected adults occurs preferentially at the carotid bifurcation and is predicted by inflammation. JAMA. 2012;1.Google Scholar
  59. 59.
    Triant VA, Meigs JB, Grinspoon SK. Association of C-reactive protein and HIV infection with acute myocardial infarction. J Acquir Immune Defic Syndr. 2009;51:268–73.PubMedCrossRefGoogle Scholar
  60. 60.
    Ford ES et al. Traditional risk factors and D-dimer predict incident cardiovascular disease events in chronic HIV infection. AIDS. 2010;24:1509–17.PubMedCrossRefGoogle Scholar
  61. 61.
    Tien PC et al. Inflammation and mortality in HIV-infected adults: analysis of the FRAM study cohort. J Acquir Immune Defic Syndr. 2010;55:316–22.PubMedCrossRefGoogle Scholar
  62. 62.
    Duprez DA et al. Inflammation, coagulation and cardiovascular disease in HIV-infected individuals. PLoS One. 2012;7:e44454.PubMedCrossRefGoogle Scholar
  63. 63.
    Kaplan RC et al. T cell activation and senescence predict subclinical carotid artery disease in HIV-infected women. J Infec Dis. 2011;203:452–63.CrossRefGoogle Scholar
  64. 64.
    Longenecker C, et al. Markers of inflammation and CD8 T-cell activation, but not monocyte activation, are associated with subclinical carotid artery disease in HIV-infected individuals. HIV Med. 2013.Google Scholar
  65. 65.
    Stein JH, et al. Ultrasonographic measures of cardiovascular disease risk in antiretroviral treatment-naive individuals with HIV infection. AIDS. 2012.Google Scholar
  66. 66.
    • Subramanian S et al. Arterial inflammation in patients with HIV. JAMA. 2012;308:379–86. Arterial inflammation as assessed by target-to-background ratio in FDG-PET was significantly increased in HIV-infected patients compared with matched control patients with similar cardiovascular risk. Monocyte activation marker sCD163 was significantly associated with arterial inflammation, reinforcing the hypothesis that immune activation plays a significant role in HIV-associated CVD.PubMedCrossRefGoogle Scholar
  67. 67.
    • Zanni MV, et al. Increased coronary atherosclerotic plaque vulnerability by coronary computed tomography angiography in HIV-infected men. AIDS. 2013. In this cross-disciplinary study utilizing advanced cardiovascular imaging techniques, HIV-infected patients had a higher prevalence of vulnerability features of coronary plaque.Google Scholar
  68. 68.
    Mendez-Lagares G et al. Long-term suppressive combined antiretroviral treatment does not normalize the serum level of Soluble CD14. J Infec Dis. 2013;207:1221–5.CrossRefGoogle Scholar
  69. 69.
    French MA et al. Serum immune activation markers are persistently increased in patients with HIV infection after 6 years of antiretroviral therapy despite suppression of viral replication and reconstitution of CD4+ T cells. J Infec Dis. 2009;200:1212–5.CrossRefGoogle Scholar
  70. 70.
    Hsue PY et al. Role of viral replication, antiretroviral therapy, and immunodeficiency in HIV-associated atherosclerosis. AIDS. 2009;23:1059–67.PubMedCrossRefGoogle Scholar
  71. 71.
    Pereyra F et al. Increased coronary atherosclerosis and immune activation in HIV-1 elite controllers. AIDS. 2012;26:2409–12.PubMedCrossRefGoogle Scholar
  72. 72.
    Funderburg NT et al. Shared monocyte subset phenotypes in HIV-1 infection and in uninfected subjects with acute coronary syndrome. Blood. 2012;120:4599–608.PubMedCrossRefGoogle Scholar
  73. 73.
    Dube MP et al. Guidelines for the evaluation and management of dyslipidemia in human immunodeficiency virus (HIV)-infected adults receiving antiretroviral therapy: recommendations of the HIV Medical Association of the Infectious Disease Society of America and the Adult AIDS Clinical Trials Group. Clin Infect Dis. 2003;37:613–27.PubMedCrossRefGoogle Scholar
  74. 74.
    Aberg JA et al. Primary care guidelines for the management of persons infected with human immunodeficiency virus: 2009 update by the HIV medicine Association of the Infectious Diseases Society of America. Clin Infect Dis. 2009;49:651–81.PubMedCrossRefGoogle Scholar
  75. 75.
    D'Agostino Sr RB. Cardiovascular risk estimation in 2012: lessons learned and applicability to the HIV population. J Infect Dis. 2012;205 Suppl 3:S362–7.PubMedCrossRefGoogle Scholar
  76. 76.
    Friis-Moller N et al. Predicting the risk of cardiovascular disease in HIV-infected patients: the data collection on adverse effects of anti-HIV drugs study. Eur J Cardiovasc Prev Rehab: Off J Eur Soc Cardiol, Work Groups Epidemiol Prev Cardiac Rehab Exerc Physiol. 2010;17:491–501.CrossRefGoogle Scholar
  77. 77.
    Lichtenstein KA et al. Provider compliance with guidelines for management of cardiovascular risk in HIV-infected patients. Preventing Chronic Disease. 2013;10:E10.PubMedCrossRefGoogle Scholar
  78. 78.
    Reinsch N et al. Are HIV patients undertreated? Cardiovascular risk factors in HIV: results of the HIV-HEART study. Eur J Prev Cardiol. 2012;19:267–74.PubMedCrossRefGoogle Scholar
  79. 79.
    Burkholder GA et al. Underutilization of aspirin for primary prevention of cardiovascular disease among HIV-infected patients. Clin Infect Dis. 2012;55:1550–7.PubMedCrossRefGoogle Scholar
  80. 80.
    Tornero CA, Ventura, Mafe M. Aspirin is indicated for primary prevention of cardiovascular events in HIV-infected patients. J Acquir Immune Defic Syndr. 2010;54:560.PubMedCrossRefGoogle Scholar
  81. 81.
    • Helleberg M et al. Mortality attributable to smoking among HIV-1-infected individuals: a nationwide, population-based cohort study. Clin Infect Dis. 2013;56:727–34. HIV-infected patients lost more life years to smoking than to HIV, in this striking recent study. These results underscore the critical importance of smoking cessation in HIV groups and provide a strong message, which providers can relay to patients.PubMedCrossRefGoogle Scholar
  82. 82.
    Lifson AR et al. Smoking-related health risks among persons with HIV in the strategies for management of antiretroviral therapy clinical trial. Am J Public Health. 2010;100:1896–903.PubMedCrossRefGoogle Scholar
  83. 83.
    Petoumenos K et al. Rates of cardiovascular disease following smoking cessation in patients with HIV infection: results from the D:A:D study (*). HIV Med. 2011;12:412–21.PubMedCrossRefGoogle Scholar
  84. 84.
    Lifson AR, Lando HA. Smoking and HIV: prevalence, health risks, and cessation strategies. Curr HIV/AIDS Rpts. 2012;9:223–30.CrossRefGoogle Scholar
  85. 85.
    Niaura R et al. Interventions to address chronic disease and HIV: strategies to promote smoking cessation among HIV-infected individuals. Curr HIV/AIDS Rpts. 2012;9:375–84.CrossRefGoogle Scholar
  86. 86.
    Vidrine DJ et al. Efficacy of cell phone-delivered smoking cessation counseling for persons living with HIV/AIDS: 3-month outcomes. Nicotine Tob Res. 2012;14:106–10.PubMedCrossRefGoogle Scholar
  87. 87.
    Huber M et al. Outcome of smoking cessation counselling of HIV-positive persons by HIV care physicians. HIV Med. 2012;13:387–97.PubMedCrossRefGoogle Scholar
  88. 88.
    Ganesan A et al. High dose atorvastatin decreases cellular markers of immune activation without affecting HIV-1 RNA levels: results of a double-blind randomized placebo controlled clinical trial. J Infect Dis. 2011;203:756–64.PubMedCrossRefGoogle Scholar
  89. 89.
    Calza L et al. Statin therapy decreases serum levels of high-sensitivity c-reactive protein and tumor necrosis factor-alpha in HIV-infected patients treated with ritonavir-boosted protease inhibitors. HIV Clin Trials. 2012;13:153–61.PubMedCrossRefGoogle Scholar
  90. 90.
    Moore RD, Bartlett JG, Gallant JE. Association between use of HMG CoA reductase inhibitors and mortality in HIV-infected patients. PLoS One. 2011;6:e21843.PubMedCrossRefGoogle Scholar
  91. 91.
    Rasmussen LD et al. Statin therapy and mortality in HIV-Infected individuals: a Danish nationwide population-based cohort study. PLoS One. 2013;8:e52828.PubMedCrossRefGoogle Scholar
  92. 92.
    Calza L et al. Two-year treatment with rosuvastatin reduces carotid intima-media thickness in HIV type 1-infected patients receiving highly active antiretroviral therapy with asymptomatic atherosclerosis and moderate cardiovascular risk. AIDS Res Hum Retroviruses. 2013;29:547–56.PubMedCrossRefGoogle Scholar
  93. 93.
    O'Brien M, et al. Aspirin attenuates platelet activation and immune activation in HIV-infected subjects on antiretroviral therapy: a pilot study. J Acquir Immune Defic Syndr. 2013.Google Scholar
  94. 94.
    • Paton NI et al. Effects of hydroxychloroquine on immune activation and disease progression among HIV-infected patients not receiving antiretroviral therapy: a randomized controlled trial. JAMA. 2012;308:353–61. Contrary to the hypothesized result, hydroxychloroquine did not reduce T cell activation among HIV-infected patients in this clinical trial. Moreover, patients randomized to the intervention arm had increased T cell decline and viral replication. These unexpected results emphasize the challenges of designing interventions to target immune activation in HIV-infected patients.PubMedCrossRefGoogle Scholar
  95. 95.
    Hatano H et al. A randomized controlled trial assessing the effects of raltegravir intensification on endothelial function in treated HIV infection. J Acquir Immune Defic Syndr. 2012;61:317–25.PubMedCrossRefGoogle Scholar
  96. 96.
    Green LA et al. Pentoxifylline reduces tumor necrosis factor-alpha and HIV-induced vascular endothelial activation. AIDS Res Hum Retroviruses. 2012;28:1207–15.PubMedCrossRefGoogle Scholar
  97. 97.
    Baker JV et al. Angiotensin converting enzyme inhibitor and HMG-CoA reductase inhibitor as adjunct treatment for persons with HIV infection: a feasibility randomized trial. PLoS One. 2012;7:e46894.PubMedCrossRefGoogle Scholar
  98. 98.
    Longenecker CT et al. Vitamin D supplementation and endothelial function in vitamin D deficient HIV-infected patients: a randomized placebo-controlled trial. Antivir Ther. 2012;17:613–21.PubMedCrossRefGoogle Scholar
  99. 99.
    Stein JH, Hsue PY. Inflammation, immune activation, and CVD risk in individuals with HIV infection. JAMA. 2012;308:405–6.PubMedCrossRefGoogle Scholar
  100. 100.
    Negoescu DM et al. Balancing immunological benefits and cardiovascular risks of antiretroviral therapy: when is immediate treatment optimal? Clin Infect Dis. 2012;55:1392–9.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Divisions of Infectious Diseases and General MedicineMassachusetts General Hospital and Harvard Medical SchoolBostonUSA

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