aMassachusetts General Hospital, Program in Nutritional Metabolism, Harvard Medical School bMassachusetts General Hospital, Yvonne L. Munn Center for Nursing Research, Boston, Massachusetts, USA.
Curr Opin HIV AIDS. 2017 Nov;12(6):585-593. doi: 10.1097/COH.0000000000000413.
To examine the epidemiology and mechanistic underpinnings of heightened cardiovascular disease (CVD) risk among women living with HIV (WLHIV) in North America and Europe.
WLHIV in North America and Europe exhibit high CVD incidence rates, which are at par with those of compatriot men living with HIV. Compared with uninfected women, WLHIV in these regions face a 2-4-fold increased relative risk for myocardial infarction, stroke, and heart failure. HIV-associated CVD risk is fuelled by a negative synergy of traditional cardiometabolic risk factors and heightened systemic immune activation/inflammation. Among WLHIV, female sex and endogenous sex hormone production influence both traditional cardiometabolic risk factors and patterns of systemic immune activation/inflammation. WLHIV in North America and Europe may also experience heightened CVD risk in relation to a relatively increased prevalence of behavioral and psychosocial CVD risk factors, coupled with suboptimal therapeutic targeting of known traditional cardiometabolic risk factors.
Additional research on sex-specific mechanisms of HIV-associated CVD - based not only out of North America and Europe but also and especially out of Africa, Asia, and South America - will inform the development of CVD prediction algorithms and prevention guidelines clinically relevant to the approximately 17 million women aging with HIV globally.
检查北美和欧洲艾滋病毒感染者（PLHIV）女性心血管疾病（CVD）风险增加的流行病学和机制基础。
北美的 PLHIV 和欧洲的 PLHIV 表现出高 CVD 发病率，与同国 HIV 男性感染者相当。与未感染者相比，这些地区的 PLHIV 发生心肌梗死、中风和心力衰竭的相对风险增加 2-4 倍。HIV 相关的 CVD 风险是由传统心血管代谢危险因素和全身性免疫激活/炎症的负面协同作用推动的。在 PLHIV 中，女性性别和内源性性激素的产生既影响传统的心血管代谢危险因素，也影响全身免疫激活/炎症的模式。北美的 PLHIV 和欧洲的 PLHIV 可能还会因行为和心理社会 CVD 危险因素的相对较高流行率而增加 CVD 风险，同时针对已知的传统心血管代谢危险因素的治疗靶向也不理想。
不仅在北美和欧洲，而且在非洲、亚洲和南美洲，开展更多关于 HIV 相关 CVD 的性别特异性机制的研究，将为 CVD 预测算法和预防指南的制定提供信息，这些算法和指南与全球约 1700 万年龄增长的 HIV 感染者有关。
