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Impact of HIV and highly active antiretroviral therapy on leukocyte adhesion molecules, arterial inflammation, dyslipidemia, and atherosclerosis

  • Stacy D. Fisher
    Affiliations
    Mid-Atlantic Cardiovascular Associates, Baltimore, MD, USA
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  • Tracie L. Miller
    Affiliations
    Department of Pediatrics (D820), Miller School of Medicine at the University of Miami and Holtz Children's Hospital of the University of Miami, Jackson Memorial Medical Center, Medical Campus-MCCD-D820, 1601 NW 12th Avenue, 9th Floor, Miami, FL 33136, USA
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  • Steven E. Lipshultz
    Correspondence
    Corresponding author. He is a member of the Sylvester Comprehensive Cancer Center. Tel.: +1 305 243 3993; fax: +1 305 243 3990.
    Affiliations
    Department of Pediatrics (D820), Miller School of Medicine at the University of Miami and Holtz Children's Hospital of the University of Miami, Jackson Memorial Medical Center, Medical Campus-MCCD-D820, 1601 NW 12th Avenue, 9th Floor, Miami, FL 33136, USA
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      Abstract

      Highly active antiretroviral therapy (HAART) has greatly extended the lives of people infected with the human immunodeficiency virus (HIV). This reduced risk of early death from opportunistic infections or other sequelae of HIV infection, however, means that other possible causes of death emerge. Myocardial infarction has become a matter of particular concern. Two of the main sources of cardiovascular disease in this population are believed to be vascular inflammation and dyslipidemia. We review the evidence for this hypothesis and discuss the relationship of HIV to vascular inflammation. Current treatment guidelines do not recommend the immediate initiation of HAART unless warranted, potentially allowing long-term, unchecked viral impact on the development of atherosclerosis. Finally, we consider the protease inhibitors traditionally included in HAART regimens and their relationship to the development of dyslipidemia, as well as other classes of antiretrovirals, such as the non-nucleoside reverse transcriptase inhibitors, which might be a better choice for patients with cardiovascular risks. Other strategies, such as pharmacologic, nutritional, and physical activity interventions are discussed. The patients who might benefit most are those in whom the precursors of vascular plaques, such as fatty streak, smooth muscle cell, macrophage, and T-lymphocyte aggregation not yet identified by echocardiographic and biopsy findings have already developed as a result of unchecked viral inflammation and replication.

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