Screening and Assessment of Coronary Heart Disease in HIV-Infected Patients

H uman immunodeficiency virus (HIV)-infected individ- uals are living longer in the era of antiretroviral therapy.As a result, they are increasingly prone to the development of concomitant chronic disease.Coronary heart disease (CHD) is the leading cause of death in the United States and Europe.Recent studies suggest that CHD rates may be increasing among HIV-infected patients (see Epidemiological Evidence for Cardiovascular Disease in HIV-Infected Patients and Relationship to Highly Active Antiretroviral Therapy, Working Group 2), and thus appropriate screening strategies for CHD in this population are needed.Recently, approaches to screening and assessment of cardiovascular disease (CVD) in HIV-infected individuals were discussed at a State of the Science Conference.Although insufficient evidence now exists to recommend a screening strategy for CHD in HIV that differs from that recommended in the non-HIV population, emerging risk factors and surrogate markers for atherosclerosis unique to the HIV population suggest specific strategies that may be useful in this population.Two broad screening categories are discussed here.The first screening strategy seeks to define the pretest likelihood of disease by identifying the presence of predisposing risk factors such as hypertension, elevated serum cholesterol, cigarette smoking, and physical inactivity.The second screening strategy aims at the detection of established CHD, even in its earliest stages.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).