Effects of HIV Infection and Antiretroviral Therapy on the Heart and Vasculature

B oth infection with human immunodeficiency virus (HIV) and treatment of HIV infection with antiretroviral drugs may affect the function of the heart and the vasculature.Direct infection of target tissues with HIV, inflammation and immunosuppression secondary to HIV infection, and common comorbidities, such as alcohol and drug abuse, may all contribute to impairment of function.Direct effects of antiretroviral drugs on the vasculature and indirect effects mediated through the metabolic complications of antiretroviral therapy (ART) 1 also appear to contribute to this impairment.The landmark Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) study found that use of HIV-1 protease inhibitors is associated with an increased risk of myocardial infarction, 2 but only part of this increased risk is mediated by the circulating lipid disturbances these drugs induce.Thus, other mechanisms by which protease inhibitors cause endothelial dysfunction, insulin resistance, and enhanced atherosclerosis are likely to be involved.The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel.Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest.The opinions expressed in this manuscript are those of the authors and should not be construed as necessarily representing an official position of the US Department of Health and Human Services, the Centers for Disease Control and Prevention, the Agency for Healthcare Research and Quality, or the US government.These opinions are not necessarily those of the editor or the American Heart Association.The Executive Summary is available in the print issue of the journal (Circulation.2008;118:198 -210).