As early and effective antiretroviral therapy has become more widespread, HIV has
transitioned from a progressive, fatal disease to a chronic, manageable disease marked
by elevated risk of chronic comorbid diseases, including cardiovascular diseases (CVDs).
Rates of myocardial infarction, heart failure, stroke, and other CVD manifestations,
including pulmonary hypertension and sudden cardiac death, are significantly higher
for people living with HIV than for uninfected control subjects, even in the setting
of HIV viral suppression with effective antiretroviral therapy. These elevated risks
generally persist after demographic and clinical risk factors are accounted for and
may be partly attributed to chronic inflammation and immune dysregulation. Data on
long-term CVD outcomes in HIV are limited by the relatively recent epidemiological
transition of HIV to a chronic disease. Therefore, our understanding of CVD pathogenesis,
prevention, and treatment in HIV relies on large observational studies, randomized
controlled trials of HIV therapies that are underpowered to detect CVD end points,
and small interventional studies examining surrogate CVD end points. The purpose of
this document is to provide a thorough review of the existing evidence on HIV-associated
CVD, in particular atherosclerotic CVD (including myocardial infarction and stroke)
and heart failure, as well as pragmatic recommendations on how to approach CVD prevention
and treatment in HIV in the absence of large-scale randomized controlled trial data.
This statement is intended for clinicians caring for people with HIV, individuals
living with HIV, and clinical and translational researchers interested in HIV-associated
CVD.