Antiretroviral therapy as a cardiovascular disease risk factor: fact or fiction? A review of clinical and surrogate outcome studies

PURPOSE OF REVIEW: The aim of this paper is to assess the contribution of antiretroviral therapy to cardiovascular disease, by evaluating relevant clinical and surrogate outcome studies. RECENT FINDINGS: A large proportion of patients receiving antiretroviral therapy develop insulin resistance and dyslipidemia, particularly if exposed to protease inhibitors. Recent findings from clinical outcome studies suggest that protease inhibitor-based therapy is associated with an increased risk of cardiovascular disease, with a consistent estimated increased risk of 1.16 to 1.17 for each additional year of protease inhibitor exposure. Antiretroviral therapy discontinuation, however, has also been linked with increased risk of cardiovascular disease. There are some data from clinical and surrogate outcome studies, that interventions addressing conventional risk factors and switching antiretroviral therapy may reduce cardiovascular disease risk. SUMMARY: Combination antiretroviral therapy in general, and protease inhibitor-based antiretroviral therapy in particular, is associated with an increased risk of cardiovascular disease. This risk is likely mediated, in part, by changes in blood lipids. The absolute risk of cardiovascular disease for the individual patient depends on his or hers composite risk profile. It is becoming increasingly important to carry out an adequate cardiovascular disease risk assessment in each patient, in order to identify patients in need of specific interventions.