aDivision of General Internal Medicine bDivision of Infectious Diseases cProgram in Nutritional Metabolism, Massachusetts General Hospital, Boston, Massachusetts, USA.
Curr Opin HIV AIDS. 2017 Nov;12(6):540-547. doi: 10.1097/COH.0000000000000410.
The purpose of this review is to summarize and synthesize recent data on the risk of ischemic heart disease (IHD) in HIV-infected individuals.
Recent studies in the field demonstrate an increasing impact of cardiovascular disease (CVD) on morbidity and mortality in HIV relative to AIDS-related diagnoses. Studies continue to support an approximately 1.5 to two-fold increased risk of IHD conferred by HIV, with specific risk varying by sex and virologic/immunologic status. Risk factors include both traditional CVD risk factors and novel, HIV-specific factors including inflammation and immune activation. Specific antiretroviral therapy (ART) drugs may increase CVD risk, yet the net effect of ART with viral suppression is beneficial with regard to CVD risk. Management of cardiovascular risk and prevention of CVD is complex, because current general population strategies target traditional CVD risk factors only. Extensive investigation is being directed at developing tailored CVD risk prediction algorithms and interventions to reduce CVD risk in HIV.
Increased IHD risk is a significant clinical and public health challenge in HIV. The development and application of HIV-specific interventions to manage CVD risk factors and reduce CVD risk will improve the long-term health of this ageing population.
本综述旨在总结和综合最近关于 HIV 感染者发生缺血性心脏病（IHD）风险的数据。
该领域的最近研究表明，与艾滋病相关的诊断相比，心血管疾病（CVD）对 HIV 患者的发病率和死亡率的影响越来越大。研究继续支持 HIV 导致 IHD 的风险增加约 1.5 至 2 倍，具体风险因性别和病毒学/免疫状态而异。风险因素包括传统的 CVD 风险因素和新型的、与 HIV 相关的因素，包括炎症和免疫激活。特定的抗逆转录病毒治疗（ART）药物可能会增加 CVD 风险，但病毒抑制的 ART 的净效应有利于 CVD 风险。心血管风险的管理和 CVD 的预防很复杂，因为目前的一般人群策略仅针对传统的 CVD 风险因素。目前正在进行广泛的研究，以制定针对 HIV 的量身定制的 CVD 风险预测算法和干预措施，以降低 CVD 风险。
IHD 风险增加是 HIV 患者面临的重大临床和公共卫生挑战。开发和应用针对 HIV 患者 CVD 风险因素的干预措施以降低 CVD 风险，将改善这一年龄化人群的长期健康状况。
