Cardiovascular Complications of HIV

Module 14, Version 4


  • Aberg JA, Gallant JE, Ghanem KG, et al. Primary care guidelines for the management of persons infected with HIV: 2013 update by the HIV medicine association of the Infectious Diseases Society of America. Clin Infect Dis. 2014;58:1-34.
  • American Diabetes Association. Standards of medical care in diabetes—2016. Diabetes Care. 2016;39(suppl 1):S1-S106.
  • Bedimo RJ, Westfall AO, Drechsler H, Vidiella G, Tebas P. Abacavir use and risk of acute myocardial infarction and cerebrovascular events in the highly active antiretroviral therapy era. Clin Infect Dis. 2011;53:84-91.
  • Bhatt DL, Steg PG, Miller M, et al. Cardiovascular risk reduction with icosapent ethyl for hypertriglyceridemia. N Engl J Med. 2019;380:11-22.
  • Boccara F, Mary-Krause M, Potard V, et al. HIV Infection and Long-Term Residual Cardiovascular Risk After Acute Coronary Syndrome. J Am Heart Assoc . 2020 ep;9(17):e017578. doi: 10.1161/JAHA.119.017578. Epub 2020 Aug 26.
  • Bush K, Teel J, Watts J, et al. Association of endothelial dysfunction and antiretroviral therapy in early HIV infection. JAMA Netw Open. 2019 Oct 2:2(10):31913615.doa: 10.1001/jamanetworkopen.2019.13615.
  • Cioe PA, Baker J, Kojic EM, et al. Elevated soluble CD14 and lower D-dimer are associated with cigarette smoking and heavy episodic alcohol use in patients living with HIV. J Acquir Immune Defic Syndr. 2015 Dec 1;70(4):400-5.
  • Deeks S, Lewin SR, Havlir DA. The end of AIDS: HIV infection as a chronic disease. Lancet. 2013;283:1525-1533.
  • De Truchis P, Kirstetter M, Perier A, et al. Reduction in triglyceride level with N-3 polyunsaturated fatty acids in HIV-infected patients taking potent antiretroviral therapy: A randomized prospective study. J Acquir Immun Defic Syndr. 2007;44:278-285.
  • Dhillon S, Sabin CA, Alagaratnam J, et al. Level of agreement between frequently used cardiovascular risk calculators in people living with HIV. HIV Med. 2019 May;20(5):347-352.
  • Ding X, Andraca-Carrera E, Cooper C, et al. No association of abacavir use with myocardial infarction: findings of an FDA meta-analysis. J Acquir Immune Defic Syndr. 2012;61:441-447.
  • Drozd DR, Kitahata MM, Althoff KN, et al. Increased risk of myocardial infarction in HIV-infected individuals in North America compared with the general population. J. Acquir. Immune Defic. Syndr. 2017 Aug 15;75(5):568-576.
  • Echeverria P, Domingo P, Llibre JM, et al. Prevalence of ischemic heart disease and management of coronary risk in daily clinical practice: Results from a Mediterranean Cohort of HIV-infected patients. Biomed Research Int. 2014;2014:823058.
  • Elion RA, Althoff KN, Zhang J, et al. Recent abacavir use increases risk for Types 1 and 2 myocardial infarctions among adults with HIV. J. Acquir Immune Syndr. 2018 Feb 6. doi:10.1097/QAI.0000000000001642. [Epub ahead of print].
  • El-Sadr WM, Lundgren J, Neaton JD, et al. CD4+ Count-guided interruption of antiretroviral treatment. New Engl J Med. 2006;355:2283-2296.
  • European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS) Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk: The Task Force for the management of dyslipidaemias of the ESC and the EAS. Eur Heart J. 2019;41(1):111-188.
  • Everett BM, Smith RJ, Hiatt WR. Reducing LDL with PCSK9 Inhibitors — the clinical benefit of lipid drugs. N Engl J Med. 2015;373:1588-1591.
  • Feinstein MJ, Bahiru E, Achenbach C, et al. Patterns of cardiovascular mortality for HIV-infected adults in the United States: 1999 to 2013. Am J Cardiol. 2016;117:214–220.
  • Feinstein MJ, Hsue PY, Benjamin LA, et al. Characteristics, prevention and management of cardiovascular disease in people living with HIV. A scientific statement from the American Heart Association. Circulation. 2019;140:e98-e124.
  • Fourman LT, Saylor CF, Cheru L, et al. Anti-inflammatory interleukin-10 is inversely related to coronary atherosclerosis in people with HIV. J Infect Dis. 2020;221:510–5.
  • Friis-Møller N, Sabin C, Weber R, et al. Combination antiretroviral therapy and the risk of myocardial infarction. N Engl J Med. 2003;349:1993-2003.
  • Friis-Møller N, Thiébaut R, Reiss P, et al. Predicting the risk of cardiovascular disease in HIV-infected patients: the data collection on adverse effects of anti-HIV drugs study. Eur J Cardiovasc Prev Rehabil. 2010;17:491-501.
  • Funderburg NT, Jiang Y, Debanne SM, et al. Rosuvastatin reduces vascular inflammation and T cell and monocyte activation in HIV-infected subjects on antiretroviral therapy. J. Acquir. Immune Defic Syndr. 2015 April 1;68(4):396-404.
  • Gatell JM, Assoumou L, Moyle G, et al. Switching from a boosted protease inhibitor (PI/r) to a dolutegravir (DTG)-based regimen for maintenance of HIV viral suppression in patients with high cardiovascular risk. AIDS. 2017 Nov 28; 31(18)2503–2514. Published online 2017 Nov 9. doi: 10:1097/QAD.000000000001675.
  • Gerber JG, Kitch DW, Fichtenbaum CJ, et al. Fish oil and fenofibrate for the treatment of hypertriglyceridemia in HIV-infected subjects on antiretroviral therapy: Results of ACTG A5186. J Acquir Immun Defic Syndr. 2008;47:459-466.
  • Goff DC Jr, Lloyd-Jones DM, Bennett G, et al. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;63(25 PtB):2935-2959.
  • Goldwater D, Karlamangla A, Merkin SS, et al. Interleukin-10 as a predictor of major adverse cardiovascular events in a racially and ethnically diverse population: Multi-Ethnic Study of Atherosclerosis. Ann Epidemiol. 2019;30:9-14.e1.
  • Golomb BA, Evans MA, Dimsdale JE, White HL. Effects of statins on energy and fatigue with exertion: Results from a randomized controlled trial. Arch Intern Med. 2012;172:1180-1182.
  • Grandi AM, Nicolini E, Rizzi L, et al. Dyslipidemia in HIV-positive patients: A randomized, controlled, prospective study on ezetimibe + fenofibrate versus pravastatin monotherapy. J Int AIDS Soc. 2014;17:19004.
  • Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2018; 10 Nov. [epub ahead of print]. DOI: 10.1161/CIR.0000000000000625.
  • Hanna DB, Moon JY, Haberlen SA, et al. Carotid artery atherosclerosis is associated with mortality in HIV+ women and men. AIDS. 2018;32:2393–2403.
  • Hoel HB, Ueland T, Knudsen A, et al. Soluble markers of IL-1 activation as predictors of first time myocardial infarction in HIV-infected individuals. J Infect Dis. 2020;221:506-9.
  • Hunt PW. HIV and inflammation: Mechanisms and consequences. Curr HIV/AIDS Rep. 2012;9:139-147.
  • James PA, Oparil S, Carter BL, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: Report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014;311:507-520.
  • Klein DB, Leyden WA, Chao CR. No difference in incidence of myocardial infarction for HIV+ and HIV- individuals in recent years. Clin Infect Dis. 2015;60:1278-1285.
  • Lakoski SG, Liu Y, Brosnihan KB, et al. Interleukin-10 concentration and coronary heart disease (CHD) event risk in the estrogen replacement and atherosclerosis (ERA) study. Atherosclerosis. 2008;197:443-7.
  • Lang S, Mary-Krause M, Cotte L, et al. Increased risk of myocardial infarction in HIV-infected patients in France, relative to the general population. AIDS. 2010;24:1228-1230.
  • Lee SE, Chang HJ, Sung JM, et al. ACC Cardiovasc Imaging. 2018 Oct;11(10):1475-1484.
  • Leyes P, Martinez E, Larrousse M, et al. Effects of ezetimibe on cholesterol metabolism in HIV-infected patients with protease inhibitor-associated dyslipidemia: A single-arm intervention trial. BMC Infect Dis. 2014;11:14:497.
  • Marcus JL, Leyden WA, Chao CR, et al. HIV infection and incidence of ischemic stroke. AIDS. 2014;28:1911-1919.
  • Martinez E, Larrousse M, Llibre JM, et al. Substitution of raltegravir for ritonavir-boosted protease inhibitors in HIV-infected patients: the SPIRAL study. AIDS. 2010;24:1697-1707.
  • McComsey GA, Kitch D, Daar ES, et al. Inflammation markers after randomization to abacavir/lamivudine or tenofovir/emtricitabine with efavirenz or atazanavir/ritonavir. AIDS. 2012;26:1371-1385.
  • Medina-Torne S, Ganesan A, Barahona I, Crum-Cianflone NF. Hypertension is common among HIV-infected persons, but not associated with HAART. J Int Assoc Physicians AIDS Care. Chic. 2012;11:20-25.
  • Monforte Ad, Reiss P, Ryom L, El-Sadr W, et al. Atazanavir is not associated with an increased risk of cardio- or cerebrovascular disease events. AIDS. 2013;27:407-415.
  • Morgello S, Mahboob R, Yakoushina T, Khan S, Hague K. Autopsy findings in human immunodeficiency virus-infected populations over 2 decades. Arch Path Lab Med. 2002;126182-126190.
  • Navarese EP, Kolodziejczak M, Kereiakes DJ, Tantry US, O’Connor C, Gurbel PA. Proprotein convertase subtilisin/kexin type 9 monoclonal antibodies for acute coronary syndrome: A narrative review. Ann Intern Med. 2016;164:600-607.
  • Paisible AL, Chang CH, So-Armah KA, et al. HIV infection, cardiovascular disease risk factor profile, and risk for acute myocardial infarction. J Acquir Immune Defic Syndr. 2015;68:209-216.
  • Palella FJ Jr, Baker RK, Moorman AC, et al. Mortality in the highly active antiretroviral therapy era: changing causes of death and disease in the HIV outpatient study. J Acquir Immune Defic Syndr. 2006;43:27–34.
  • Palella FJ Jr, Fisher M, Tebas P, et al. Simplification to rilpivirine/emtricitabine/tenofovir disoproxil fumarate from ritonavir-boosted protease inhibitor antiretroviral therapy in a randomized trial of HIV-1 RNA-suppressed participants. AIDS. 2014; 28:335 344.
  • Petoumenos K, Worm S, Reiss P, et al. Rates of cardiovascular disease following smoking cessation in patients with HIV infection: Results from the D:A:D Study. HIV Med. 2011;12:412-421.
  • Pool ER, Dogar O, Lindsay RP. Et al. Interventions for tobacco use cessation in people living with HIV and IADS. Cochrane Database Syst Rev. 2016;13(6):CD011120.
  • Post WS, et al. Associations between HIV infection and subclinical coronary atherosclerosis. Ann Intern Med. 2014;160:458-467.
  • Qaseem A, Wilt TJ, Rich R, et al. Pharmacologic treatment of hypertension in adults aged 60 years or older to higher versus lower blood pressure targets: A clinical practice guideline from the American College of Physicians and the American Academy of Family Physicians. Ann Intern Med. 2017;166(6):430-437.
  • Ridker PM, Pradhan A, MacFadyen JG, Libby P, Glynn RJ. Cardiovascular benefits and diabetes risks of statin therapy in primary prevention: An analysis from the JUPITER trial. Lancet. 2012;380:565-571.
  • Rosendorff C, Lackland DT, Allison M, et al. Treatment of hypertension in patients with coronary artery disease: A scientific statement from the AHA, ACC, and ASH. Circulation. 2015;131:e435-e470.
  • Sabatine MS, Giugliano RP, Keech AC, et al. Evolocumab and clinical outcomes in patients with cardiovascular disease. N Engl J Med. 2017;376:1713-1722.
  • Sabin C, Reiss P, Ryom L, et al. Is there continued evidence for an association between abacavir usage and myocardial infarction risk in individuals with HIV? A cohort collaboration. BMC Med. 2016;14:61.
  • Saeedi R, Johns K, Frohlich J, et al. Lipid lowering efficacy and safety of ezetimibe combined with rosuvastatin compared with titrating rosuvastatin monotherapy in HIV-positive patients. Lipids Health Dis. 2015;14:57.
  • Shah ASV, Stelzle D, Lee KK, et al. Global burden of atherosclerotic cardiovascular disease in people living with HIV: systematic review and meta-analysis. Circulation. 2018;138:1100–1112.
  • Silverberg MJ, Leyden WA, Xu L, et al. Immunodeficiency and risk of myocardial infarction among HIV-positive individuals with access to care. J Acquir Immune Defic Syndr. 2014;65:160-166.
  • Sing S, Willig JH, Mugavero MJ, et al. Comparative efficacy and toxicity among statins in HIV-infected patients. Clin Infect Dis. 2011;52:387-395.
  • SPRINT Research Group. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med. 2015;373:2103-2116.
  • Strategies for Management of Anti-Retroviral Therapy/INSIGHT; DAD Study Groups. Use of nucleoside reverse transcriptase inhibitors and risk of myocardial infarction in HIV-infected patients. AIDS. 2008;22:F17-F24.
  • Subramanian S, Tawakol A, Burdo TH, et al. Arterial inflammation in patients with HIV. JAMA. 2012;308:379-386.
  • Subramanya V, McKay HS, Brusca RM, et al. Inflammatory biomarkers and subclinical carotid atherosclerosis in HIV-infected and HIV-uninfected me in the Multicenter AIDS Cohort Study. PLoS One. 2019 Apr 4;14(4):e0214735.
  • Suchindran S, Regan S, Meigs JB, Grinspoon SK, Triant VA. Aspirin use and myocardial infarction in HIV versus non-HIV patients. Circulation. 2013;127:A030.
  • Tawakol A, Lo J, Zanni MV, et al. Increased arterial inflammation relates to high-risk coronary plaque morphology in HIV-infected patients. J Acquir Immune Defic Syndr. 2014;66:164-171.
  • Tenorio AR, Zheng Y, Bosch RJ, et al. Soluble markers of inflammation and coagulation but not activation predict non-AIDS-defining morbid events during suppressive antiretroviral treatment. J Infect Dis. 2014 Oct 15;210(8):1248-59.
  • Thiebaut R, El-Sadr WM, Friis-Moller N, et al. Predictors of hy­pertension and changes in blood pressure in HIV-infected patients. Antiviral Ther. 2005;10:811-823.
  • Torriani FJ, Komarow L, Parker RA, et al. Endothelial function in human immunodeficiency virus-infected antiretroviral naïve subjects before and after starting potent antiretroviral therapy: The ACTG (AIDS Clinical Trials Group) Study 5152s. J Am Coll Cardiol. 2008;52:569-576.
  • Triant VA, Meigs JB, Grinspoon SK. Association of c-reactive protein and HIV infection with acute myocardial infarction. J Acquir Immune Defic Syndr. 2009;51:268-273.
  • Triant VA, Perez J, Regan S, et al. Cardiovascular risk prediction function underestimates risk in HIV infection. 2018; CIRCULATION AHA.117.028975.
  • Triant VA. Cardiovascular disease and HIV infection. Curr HIV/AIDS Rep. 2013;10:199-206.
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  • Van Lelyveld SF, Gras L, Kesselring A, et al. Long-term complications in patients with poor immunological recovery despite virological successful HAART in Dutch ATHENA cohort. AIDS. 2012;26:465-474.
  • Welsh P, Murray HM, Ford I, et al.; PROSPER Study Group. Circulating interleukin-10 and risk of cardiovascular events: a prospective study in the elderly at risk. Arterioscler Thromb Vasc Biol 2011;31:2338–44.
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  • Wohl DA, Tien HC, Busby M, et al. Randomized study of the safety and efficacy of fish oil (omega-3 fatty acid) supplementation with dietary and exercise counseling for the treatment of antiretroviral therapy associated hypertriglyceridemia. Clin Infect Dis. 2005;41:1498-1504.
  • Worm S, Kamara A, El-Sadr W, et al. Elevated triglycerides and risk of myocardial infarction in HIV-positive persons. AIDS. 2011;25:1497-1504.
  • Worm S, Sabin C, Weber R, et al. DAD Study Group. Risk of myocardial infarction in patients with HIV infection exposed to specific individual antiretroviral drugs from 3 major drug classes. J Infect Dis. 2010;201:318-330.
  • Yen YF, Ko MC, Yen MY, et al. Human Immunodeficiency Virus Increases the Risk of Incident Heart Failure. J Acquir Immune Defic Syndr. 2019;80:255–2.
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  • Crothers K, Harding BN, Whitney BM, et al. COPD and the risk of MI by type in people living with HIV. Conference on Retroviruses and Opportunistic Infections (CROI). March 4-7, 2019. Seattle. Abstract 31.
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  • Ryom L, Lundgren JD, El-Sadr WM, et al. Association between cardiovascular disease and contemporarily used protease inhibitors. Program and abstracts of Conference on Retroviruses and Opportunistic Infections (CROI), February 13-16, 2017, Seattle. Abstract 128LB.
  • Willig AL, Westfall AO, Crane HM, et al. The beneficial effects of physical activity in the setting of HIV infection. Program and abstracts of the 18th International Workshop on Co-morbidities and Adverse Drug Reactions in HIV; September 12-13, 2016; New York, New York. Abstract O12.

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