Antiretroviral therapy has revolutionized the care of people with human immunodeficiency
virus (HIV) by reducing morbidity and mortality from acquired immunodeficiency syndrome–related
conditions. Despite longer life expectancy, however, HIV-infected individuals continue
to have a higher risk of death compared with the general population. This has been
attributed to the increasing incidence of noncommunicable diseases, in particular,
atherosclerotic cardiovascular diseases. This is driven, in part, by the emergence
of metabolic disorders, particularly dyslipidemia, insulin resistance, and lipodystrophy,
in those on antiretroviral therapy. The pathogenesis of these metabolic derangements
is complex and multifactorial, and could be a consequence of an interplay between
traditional age-related risk factors, HIV infection, antiretroviral therapy effects,
and the inflammatory state and immune activation in this population. Understanding
the contributions of each of these factors could not just impact the current management
of these individuals and help mitigate the risk for premature cardiovascular disease,
but also shape the future direction of research in HIV.
Abbreviations:
ABCA1 (adenosine-triphosphate-binding cassette transporter A1), AIDS (acquired immunodeficiency syndrome), AMI (acute myocardial infarction), Apo-B (apolipoprotein B), cART (combined antiretroviral therapy), CRP (c-reactive protein), DM (diabetes mellitus), HDL-C (high-density lipoprotein-cholesterol), HIV (human immunodeficiency virus), HMG-CoA (3-hydroxy-3-methyl-glutaryl-coenzyme A), HOMA-IR (homeostatic model assessment-IR), IL (interleukin), IR (insulin resistance), JNK (c-Jun N-terminal kinase), LDL-C (low-density lipoprotein-cholesterol), LRP1 (LDL receptor–related protein type 1), mtDNA (mitochondrial DNA), NNRTI (non-nucleoside reverse transcriptase inhibitors), NRTI (nucleoside reverse transcriptase inhibitors), PI (protease inhibitors), PPAR-γ (proliferator-activated receptors-gamma), SAT (subcutaneous adipose tissue), SREBP (sterol regulatory element–binding protein), TC (total cholesterol), TG (triglyceride), TNF-α (tumor necrosis factor-alpha), tNRTI (thymidine nucleoside reverse transcriptase inhibitors), VAT (visceral adipose tissue), VLDL (very low-density lipoprotein), Vpr (viral protein (of HIV))To read this article in full you will need to make a payment
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Article info
Publication history
Published online: December 22, 2016
Accepted:
December 15,
2016
Received in revised form:
November 18,
2016
Received:
September 16,
2016
Footnotes
Conflict of interest: None.
Source of Funding: None.
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.
