The face of HIV has changed drastically since the unusual infections were initially reported in young, gay men in the early 1980s. Key to this was the identification of the human immunodeficiency virus and development and evolution of antiretroviral therapy.
As a result, death from HIV was no longer inevitable, and patients are now often able to live productive and disease-free lives. Many are living full lives and to ages similar to the general population.
However, now in the age of viral suppression, there are new problems that impact on the health and quality of life of patients infected with HIV. Diseases of aging have become the leading causes of morbidity and mortality in this patient population. Cardiovascular disease and cancer are becoming more common in these patients. It is important for the clinician to become familiar with diagnosis and management of cardiovascular disease and perhaps even more important—recognizing and treating risk factors that result in manifest cardiovascular disease.
Epidemiology Antiretroviral therapy Cardiovascular disease HIV
This is a preview of subscription content, log in to check access.
Gottlieb MS, Schroff R, Schanker HM, Weisman JD, Fan PT, Wolf RA, et al. Pneumocystis carinii pneumonia and mucosal candidiasis in previously healthy homosexual men: evidence of a new acquired cellular immunodeficiency. N Engl J Med. 1981;305(24):1425–31.CrossRefGoogle Scholar
Masur H, Michelis MA, Greene JB, Onorato I, Stouwe RA, Holzman RS, et al. An outbreak of community-acquired pneumocystis carinii pneumonia: initial manifestation of cellular immune dysfunction. N Engl J Med. 1981;305(24):1431–8.CrossRefGoogle Scholar
Siegal FP, Lopez C, Hammer GS, Brown AE, Kornfeld SJ, Gold J, et al. Severe acquired immunodeficiency in male homosexuals, manifested by chronic perianal ulcerative herpes simplex lesions. N Engl J Med. 1981;305(24):1439–44.CrossRefGoogle Scholar
Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Kumarasamy N, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011;365(6):493–505.CrossRefGoogle Scholar
Lundgren JD, Babiker AG, Gordin F, Emery S, Grund B, Sharma S, et al. Initiation of antiretroviral therapy in early asymptomatic HIV infection. N Engl J Med. 2015;373(9):795–807.CrossRefGoogle Scholar
Marcus JL, Chao CR, Leyden WA, Xu L, Quesenberry CP Jr, Klein DB, et al. Narrowing the gap in life expectancy between HIV-infected and HIV-uninfected individuals with access to care. J Acquir Immune Defic Syndr. 2016;73(1):39–46.CrossRefGoogle Scholar
Smit M, Brinkman K, Geerlings S, Smit C, Thyagarajan K, Sighem A, et al. Future challenges for clinical care of an ageing population infected with HIV: a modelling study. Lancet Infect Dis. 2015;15(7):810–8.CrossRefGoogle Scholar
Smith C, Sabin CA, Lundgren JD, Thiebaut R, Weber R, Law M, et al. Factors associated with specific causes of death amongst HIV-positive individuals in the D:A:D study. AIDS. 2010;24(10):1537–48.PubMedGoogle Scholar
Triant VA, Lee H, Hadigan C, Grinspoon SK. Increased acute myocardial infarction rates and cardiovascular risk factors among patients with human immunodeficiency virus disease. J Clin Endocrinol Metab. 2007;92(7):2506–12.CrossRefGoogle Scholar
Freiberg MS, Chang CC, Kuller LH, et al. HIV infection and the risk of acute myocardial infarction. JAMA Intern Med. 2013;173(8):614–22.CrossRefGoogle Scholar
Grinspoon SK, Grunfeld C, Kotler DP, et al. State of the science conference: initiative to decrease cardiovascular risk and increase quality of care for patients living with HIV/AIDS: executive summary. Circulation. 2008;118(2):198–210.CrossRefGoogle Scholar
Libby P, Ridker PM, Maseri A. Inflammation and atherosclerosis. Circulation. 2002;105(9):1135–43.CrossRefGoogle Scholar
El-Sadr WM, Lundgren J, Neaton JD, et al. CD4+ count-guided interruption of antiretroviral treatment. N Engl J Med. 2006;355(22):2283–96.CrossRefGoogle Scholar
Magkos F, Mantzoros CS. Body fat redistribution and metabolic abnormalities in HIV-infected patients on highly active antiretroviral therapy: novel insights into pathophysiology and emerging opportunities for treatment. Metab Clin Exp. 2011;60(6):749–53.CrossRefGoogle Scholar
Kaplan-Lewis E, Aberg JA, Lee M. Atherosclerotic cardiovascular disease and anti-retroviral therapy. Curr HIV/AIDS Rep. 2016;13(5):297–308.CrossRefGoogle Scholar
Myerson M, Poltavskiy E, Armstrong EJ, Kim S, Sharp V, Bang H. Prevalence, treatment, and control of dyslipidemia and hypertension in 4278 HIV outpatients. J Acquir Immune Defic Syndr. 2014;66(4):370–7.CrossRefGoogle Scholar
Medina-Torne S, Ganesan A, Barahona I, Crum-Cianflone NF. Hypertension is common among HIV-infected persons, but not associated with HAART. J Int Assoc Phys AIDS Care (Chicago, Ill: 2002). 2012;11(1):20–5.CrossRefGoogle Scholar