Coronary Artery Disease


  • HIV infection increases coronary atherosclerosis and risk of acute coronary syndromes (ACS): 1-2x increased risk; 6-15% of deaths among HIV+ in U.S. and Europe caused by cardiovascular disease
    • Proposed mechanisms: HIV-mediated inflammation, immune activation, immune dysregulation (abnorml CD4:CD8 ratio), coagulation disorders, lipid disturbances, gut translocation, and exposure to specific ART agents
  • ART substantially reduces CVD risk, but does not neutralize the risk for all people living with HIV.
  • ART agents in the past have had a contribution to CVD risk (LPV/r, IDV, ABC, ddI). Current agents (except possibly for ABC) are not directly associated with CVD risk.
  • Traditional risk factors:
    • Hypercholesterolemia and low HDL
    • Hypertension
    • Diabetes
    • Central obesity
    • Genetics (family history of MI < 55 yrs)
    • Advancing age
  • Behavioral factors
    • Smoking
    • Recreational drug use (especially cocaine)
    • Lack of exercise
    • Poor food choices

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Last updated: March 4, 2023