Vascular injury, hypertension and coronary artery disease in human immunodeficiency virus infection.

The atherogenic effects of some highly active antiretroviral therapy (HAART) regimens, especially those including protease inhibitors (PI), may synergistically promote the acceleration of cardiovascular disease and increase the risk of death from cardiovascular events even in young HIV-infected people. Along with the endothelial dysfunction associated with visceral fat accumulation and related metabolic alterations of HIV-lipodystrophy syndrome (eg, insulin resistance), vascular injury has been associated with HIV-1 infection itself, with an autoimmune reaction to viral infection (vasculitis) and with a direct action of drugs included in HAART regimens. Clinical studies suggest that HIV-infected patients under PI-including HAART and with preexisting cardiovascular risk factors, should be considered at risk for developing coronary artery disease, and that this risk increases with the time of exposure to HAART. A careful cardiovascular screening and monitoring of HIV-infected patients receiving HAART is needed according to the most recent clinical guidelines.