Protecting the heart after HAART: understanding the pathogenesis of cardiovascular disease in people living with HIV

Advances in the management of HIV and antiretroviral therapy (ART) have led to substantial improvements in diseasefree survival for patients with HIV. Life-expectancy is approaching that of the general population. Yet these gains have been tempered by increasing rates of non-AIDS-related co-morbidities. In fact the major burden of illness, health care utilisation and premature death in HIV positive patients is now due to diseases of ageing. Cardiovascular disease (CVD) occurs at two times the rate in the general population and is a cause of significant morbidity and mortality. Lifestyle factors such as cigarette smoking and underlying genetics are clearly important. Yet in HIV patients CVD is also promoted by complex interactions between HIV and ART driven coagulation, dyslipidaemia, inflammation and immune dysfunction. Understanding the pathogenesis of CVD in HIV will be of increasing importance as the HIV population ages. This will enable targeted prevention strategies and personalised antiretroviral regimens to be utilised. Some of the recent advances in the field are discussed in this review.