Does HIV Cause Cardiovascular Disease?

Cardiovascular disease is an increasing cause of morbidity in HIV-infected adults receiving antiretroviral therapy (ART). ART, particularly protease inhibitors and to a lesser extent nucleoside analogue reverse transcriptase inhibitors, can adversely affect lipid and glucose metabolism [1]. Moreover, there is a strong correlation between ART duration and the risk of myocardial infarction, an association in part linked to higher plasma levels of total cholesterol and triglyceride and to lower levels of high-density lipoprotein (HDL) cholesterol [2]. Paradoxically, interruption of ART also appears to be associated with an increased short-term risk of cardiovascular disease [3]. These fi ndings suggest that HIV itself may also increase cardiovascular risk, and that control of HIV replication might reduce this risk. HDL cholesterol levels are reduced in untreated HIV infection [4] and in healthy volunteers exposed for a short term to the HIV protease inhibitors ritonavir-boosted atazanavir and lopinavir [5,6]. In HIV-infected individuals who start ART that effectively suppresses HIV replication, HDL cholesterol levels increase, regardless of whether a protease inhibitor is used [7–9], implying that the HIV effect on HDL cholesterol levels is greater than the ART effect.