Myocardial infarction risk in HIV-infected patients: epidemiology, pathogenesis, and clinical management

Highly active antiretroviral therapy (HAART) has dramatically reduced morbidity and mortality associated with acquired immunodeficiency syndrome (AIDS), and human immunodeficiency virus (HIV) infection has become a chronic and manageable disease. Paralleling increased life expectancy, HIV-infected subjects may present many comorbidities, most notably cardiovascular diseases, and recent studies have identified an increased prevalence of traditional coronary risk factors in these patients. Moreover, additional investigations suggest that HIV itself may independently favour premature atherosclerosis, and antiretroviral agents also could directly or indirectly play a role in the atherosclerotic process. Dyslipidaemia, insulin resistance, inflammation, and fat redistribution are all likely to contribute to this pathogenetic pathway, and these abnormalities may be interrelated and due to either HIV infection, or the related inflammatory syndrome, or HAART-associated toxicity. Appropriate screening and assessment of cardiovascular risk and intensive strategies for prevention of cardiovascular events are suitable in HIV-infected patients, including lifestyle measures, switching antiretroviral drugs, and pharmacologic therapy of lipid and glucose metabolism alterations. This article reviews the correlation between HIV infection and myocardial infarction, and discusses the most appropriate clinical management of cardiovascular risk among HIV-positive individuals