HIV and Cardiovascular Disease: An Increasing Concern

People living with HIV (PLWH) face a significantly elevated risk of cardiovascular disease (CVD), a trend increasingly recognized by medical researchers. Whereas advancements in antiretroviral therapy (ART) have dramatically improved the lifespan and overall health of individuals with HIV, they haven’t eliminated the heightened susceptibility to heart-related complications. This article explores the connection between HIV and CVD, the underlying mechanisms, recent findings, and ongoing research efforts.

The Link Between HIV and Cardiovascular Disease

Historically, CVD was less prevalent in PLWH due to shorter life expectancies. However, with effective ART extending lifespans, the incidence of CVD in this population has risen dramatically. PLWH now experience a higher prevalence of coronary artery disease, including coronary plaque, than their HIV-negative counterparts.

Inflammation: A Key Driver

Chronic inflammation is a central factor linking HIV, and CVD. HIV infection triggers persistent immune activation, leading to systemic and vascular inflammation. Both innate and adaptive immune systems contribute to this inflammatory state. This inflammation accelerates the development of atherosclerosis – the buildup of plaque in the arteries – and increases the risk of events like heart attack and stroke.

Monocytes and the Immune Response

Research indicates that specific immune cells, particularly monocytes, play a crucial role in this process. Studies have focused on circulating non-classical monocytes (NCM) and intermediate monocytes (IM). In women with HIV, these monocyte populations exhibit altered gene expression, even with well-controlled viral loads. Interestingly, the presence of subclinical CVD alongside HIV infection further amplifies these gene expression changes. The gene expression signature observed in monocytes suggests a potential role as viral reservoirs and highlights their involvement in the inflammatory response.

Prevalence and Severity of Coronary Artery Disease

A substudy of the REPRIEVE trial revealed that approximately half of participants with well-controlled HIV had coronary plaque. While most plaque was limited, a concerning obstruction was found in less than 3% of participants. The presence of coronary plaque was associated with higher levels of markers indicating immune function and inflammation.

Types of Cardiovascular Pathology

The spectrum of cardiovascular pathology observed in PLWH is broad. Prevalence ranges from 0% to 52% for moderate to severe coronary disease and 5% to 84% for myocardial fibrosis.

Future Directions and Research

Ongoing research is focused on understanding the precise mechanisms driving CVD in PLWH and identifying potential therapeutic targets. The identification of genes like LAG3 (CD223) as potential drug targets offers promising avenues for intervention. Further studies are needed to determine the optimal strategies for preventing and managing CVD in this vulnerable population, including the role of lipid-lowering treatments and interventions to reduce inflammation.

Key Takeaways

• PLWH have a higher risk of cardiovascular disease than HIV-negative individuals.
• Chronic inflammation is a key driver of CVD in PLWH.
• Monocytes play a significant role in the inflammatory response and may serve as viral reservoirs.
• Approximately half of PLWH with well-controlled HIV have coronary plaque.
• Ongoing research is exploring new therapeutic targets to prevent and manage CVD in this population.