Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.
Curr Opin HIV AIDS. 2011 Jul;6(4):266-71. doi: 10.1097/COH.0b013e328347876c.
Highly active antiretroviral therapy (HAART) use has markedly reduced AIDS-related mortality and opportunistic illness. With improved survival, cardiovascular disease (CVD) has emerged as an important noninfectious chronic comorbidity among antiretroviral (ARV)-treated HIV-infected persons.
HIV infection can impact CVD and comorbidities known to increase CVD risk. Untreated HIV can cause proatherogenic elevations in serum lipids. Chronic HIV viremia results in increases in systemic inflammation, hypercoagulation, and reductions in endovascular reactivity, all of which are at least partially reversible with virally suppressive HAART. Chronic T-cell activation can also result in adverse vascular effects. Use of some ARV drugs can impact CVD risk by causing pro-atherogenic serum lipid elevations, induction of insulin resistance, increases in visceral adiposity or subcutaneous fat loss. Abacavir use may increase myocardial infarction risk by reducing vascular reactivity and/or increasing platelet activation. Traditional risk factors such as advancing age, smoking, hyperlipidemia, and hypertension remain important predictors of CVD among HAART-treated HIV-infected persons.
HIV in the HAART era is a chronic manageable condition. CVD is an important cause of morbidity among HIV-infected persons. Untreated HIV can increase CVD risk in several ways and these effects are at least partially reversible with successful treatment. Use of specific ARVs can adversely impact CVD risk but the multiple long-term benefits of chronic HIV suppression and immune reconstitution achievable with potent HAART outweigh the adverse impact upon CVD risks that they may have. Standard CVD screening and risk-reducing interventions should be routinely undertaken for HIV-infected persons.
高效抗逆转录病毒疗法（HAART）的使用显著降低了艾滋病相关死亡率和机会性感染。随着生存时间的延长，心血管疾病（CVD）已成为接受抗逆转录病毒（ARV）治疗的 HIV 感染者中重要的非传染性慢性合并症。
HIV 感染会影响 CVD 和已知增加 CVD 风险的合并症。未经治疗的 HIV 可引起血清脂质产生促动脉粥样硬化的升高。慢性 HIV 病毒血症导致全身炎症、高凝状态和血管内反应性降低，所有这些都至少部分可通过抑制病毒的 HAART 逆转。慢性 T 细胞激活也会导致不良的血管效应。一些 ARV 药物的使用可通过引起促动脉粥样硬化的血清脂质升高、诱导胰岛素抵抗、内脏脂肪增加或皮下脂肪减少来影响 CVD 风险。阿巴卡韦的使用可能通过降低血管反应性和/或增加血小板激活来增加心肌梗死的风险。在接受 HAART 治疗的 HIV 感染者中，传统的危险因素，如年龄增长、吸烟、血脂异常和高血压，仍然是 CVD 的重要预测因素。
在 HAART 时代，HIV 是一种可以长期控制的疾病。CVD 是 HIV 感染者发病和致残的重要原因。未经治疗的 HIV 可以通过多种方式增加 CVD 风险，这些影响至少部分可通过成功治疗逆转。特定的 ARV 的使用会对 CVD 风险产生不利影响，但通过强效 HAART 实现的慢性 HIV 抑制和免疫重建的多种长期益处超过了它们可能对 CVD 风险产生的不利影响。应常规为 HIV 感染者进行 CVD 筛查和降低风险干预。
