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Epidemiology of cardiovascular disease and risk factors in HIV-infected patients

Author
Judith S Currier, MD
Section Editor
John G Bartlett, MD
Deputy Editor
Allyson Bloom, MD

INTRODUCTION

For those who have access to potent antiretroviral therapy (ART), the overall incidence of AIDS or death related to infection by HIV has decreased dramatically [1]. Prior to 1996, the annual mortality rate among individuals with HIV-1 infection exceeded 20 percent; after a decade of effective treatment, annual mortality has declined to less than 2 percent [2].

Following the introduction of combination ART, new concerns arose among individuals using these regimens, including increased prevalence of fat redistribution, lipoatrophy, fat accumulation, or a mixed picture of both [3,4]. In addition to the changes in fat distribution, other metabolic abnormalities observed in patients on combination ART included dyslipidemia, diabetes mellitus, insulin resistance, and hepatic steatosis [5]. There is concern that these metabolic disturbances, along with other factors, lead to an increased risk for cardiovascular disease [6].

This topic will address the epidemiology of cardiovascular morbidity and mortality and cardiovascular risk factors in the setting of HIV infection and treatment. The incidence of subclinical atherosclerosis and the pathogenesis of cardiovascular disease in HIV-infected patients are discussed in detail elsewhere. (See "Pathogenesis and biomarkers of cardiovascular disease in HIV-infected patients".)

Management of dyslipidemia in HIV-infected patients, HIV lipodystrophy, and HIV-associated cardiac complications, such as pericarditis, myocarditis, pulmonary hypertension, and cardiomyopathy, are discussed separately. (See "Management of cardiovascular risk (including dyslipidemia) in the HIV-infected patient" and "Cardiac and vascular disease in HIV-infected patients" and "Epidemiology, clinical manifestations, and diagnosis of HIV-associated lipodystrophy".)

CARDIOVASCULAR DISEASE ASSOCIATED WITH HIV INFECTION

With more effective and widespread treatment of HIV in resource-rich settings, morbidity and mortality from non-AIDS-related events have surpassed those from AIDS-related events [7-9]. In particular, cardiovascular disease has emerged as an important cause of death in HIV-infected patients relative to the decreasing incidence of opportunistic disease. Several lines of evidence, from modeling of calculated cardiovascular risk to clinical studies evaluating such hard endpoints as stroke, myocardial infarctions (MIs), and sudden cardiac death have cumulatively supported this finding [10-16]. The data evaluating the rate of cardiovascular disease in HIV-infected patients compared with uninfected populations and its association with antiretroviral therapy (ART) and HIV disease state are discussed below.

                             

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Literature review current through: Nov 2016. | This topic last updated: Thu Aug 11 00:00:00 GMT+00:00 2016.
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