Rational Pharmacotherapy in Cardiology

Advanced search

Coronary Heart Disease in HIV-Infected Patients

Full Text:


Currently, there are methods of drug exposure to the infection caused by the human immunodeficiency viruses (HIV), that allow to suppress the active replication of the virus in the patient's body. The era of antiretroviral therapy, which has allowed HIV-infected people to live longer, has begun. This led to an increase in their cardiovascular diseases, which occur at an earlier age and are more severe than in people without HIV. Specific or “nontraditional” risk factors damaging vascular wall occur in HIV patients along with traditional risk factors. These factors include: the negative impact of HIV on endothelium, an imbalance of inflammatory mediators, pathological immune activation, a decrease in the level of CD4 cells, a change in the number and function of platelets. The question of the effect of antiretroviral therapy on the occurrence of atherosclerotic vascular lesions remains debatable. Acute coronary syndrome (ACS) is one of the most frequent and most severe cardiovascular events in HIV-infected patients. The risk of myocardial infarction is highest in patients with a viral load of HIV-1 ribonucleic acid (RNA)≥500 copies/ml and a CD4 cell count of <200/ml. The most common form of ACS in HIV patients is ACS with ST segment elevation. Treatment of ACS in HIV patients has some difficulties: a high frequency of stent thrombosis, the frequent occurrence of thrombocytopenia, drug interactions with antiretroviral therapy. The high risk of developing cardiovascular diseases in HIV patients necessitates the introduction of active measures of primary and secondary prevention, taking into account the specific interaction of all drugs taken by the patient.

About the Authors

M. A. Arzhakova
Samara State Medical University
Russian Federation

Maria A. Arzhakova – MD, Resident, Chair of Cardiology and Cardiovascular Surgery

Artsybushevskaya ul. 171, Samara, 443001

T. A. Shekhovtsova
Samara State Medical University
Russian Federation

Tatyana A. Shekhovtsova – MD, Resident, Chair of Cardiology and Cardiovascular Surgery

Artsybushevskaya ul. 171, Samara, 443001

D. V. Duplyakov
Samara State Medical University; Samara Regional Clinical Cardiology Dispensary
Russian Federation

Dmitry V. Duplyakov – MD, PhD, Professor, Chair of Cardiology and Cardiovascular Surgery, Samara State Medical University; Deputy Chief Medical Officer, Samara Regional Clinical Cardiology Dispensary  

Artsybushevskaya ul. 171, Samara, 443001, 

Aerodromnaya ul. 43, Samara, 443070


1. UNAIDS report on the global AIDS epidemic 2010 [cited by Nov 15, 2019]. Available from:

2. HIV/AIDS surveillance in Europe 2018. 2017 data. Surveillance report. Copenhagen: WHO; 2018. [cited by Nov 15, 2019]. Available from:

3. Bloomfield G.S., Leung C. Cardiac Disease Associated with Human Immunodeficiency Virus Infection. Cardiol Clin. 2017;35(1):59-70. DOI:10.1016/j.ccl.2016.09.003.

4. Barnes R.P., Lacson J.C.A., Bahrami H. HIV Infection and Risk of Cardiovascular Diseases Beyond Coronary Artery Disease. Curr Atheroscler Rep. 2017;19(5):20. DOI:10.1007/s11883-017-0652-3.

5. Bozzette S., Ake C.F., Tam H.K., et al. Cardiovascular and cerebrovascular events in patients treated for human immunodeficiency virus infection. N Engl J Med. 2003;348(8):702-10. DOI:10.1056/NEJMoa022048.

6. Seecheran V.K., Giddings S.L., Seecheran N.A. Acute coronary syndromes in patients with HIV. Coron Artery Dis. 2017;28(2):166-72. DOI:10.1097/MCA.0000000000000450.

7. Zaaqoq A.M., Khasawneh F.A., Smalligan R.D. Cardiovascular Complications of HIV-Associated Immune Dysfunction. Cardiol Res Pract. 2015;2015:02638. DOI:10.1155/2015/302638.

8. Lonardo A., Ballestri S., Guaraldi G., et al. Fatty liver is associated with an increased risk of diabetes and cardiovascular disease Evidence from three different disease models: NAFLD, HCV and HIV. World J Gastroenterol. 2016;22(44):9674-93. DOI:10.3748/wjg.v22.i44.9674.

9. Wang T., Yi R., Green L.A., et al. Increased Cardiovascular Disease Risk In The HIV-Positive Population on ART: Potential Role of HIV-Nef and Tat. Cardiovasc Pathol. 2015;24(5):279-82. DOI:10.1016/j.carpath.2015.07.001.

10. Lichtenstein K.A., Armon C., Buchacz K., et al. Low CD4+ T cell count is a risk factor for cardiovascular disease events in the HIV outpatient study. Clin Infect Dis. 2010;51(4):435-47. DOI:10.1086/655144.

11. Kuller L.H., Tracy R., Belloso W., et al. Inflammatory and coagulation biomarkers and mortality in patients with HIV infection. PLoS Med. 2008;5(10):e203. DOI:10.1371/journal.pmed.0050203.

12. Gary S.M., Bruno R.C. HIV and cardiovascular disease: much ado about nothing? Eur Heart J. 2018;39(23):2155-7. DOI:10.1093/eurheartj/ehy248.

13. Nasi M., De Biasi S., Gibellini L., et al. Ageing and inflammation in patients with HIV infection. Clin Exp Immunol. 2017;187(1):44-52. DOI:10.1111/cei.12814.

14. Madden E., Lee G., Kotler D.P., et al. Association of antiretroviral therapy with fibrinogen levels in HIV-infection. AIDS. 2008;22(6):707-15. DOI:10.1097/QAD.0b013e3282f560d9.

15. Aberg J.A. Aging, inflammation, and HIV infection. Topics in Antiviral Medicine. 2012;20(3): 101-5.

16. Sylwester A.W., Mitchell B.L., Edgar J.B., et al., Broadly targeted human cytomegalovirus-specific CD4+ and CD8+ T cells dominate the memory compartments of exposed subjects. The Journal of Experimental Medicine. 2005;202(5):673-85. DOI:10.1084/jem.20050882.

17. D’Ascenzo F., Cerrato E., Biondi-Zoccai G., et al. Acute coronary syndromes in human immunodeficiency virus patients: a meta-analysis investigating adverse event rates and the role of antiretroviral therapy. Eur Heart J. 2012;33:875-80. DOI:10.1093/eurheartj/ehr456.

18. Desvarieux M., Boccara F., Meynard J.L., et al. Infection duration and inflammatory imbalance are associated with atherosclerotic risk in HIV-infected never-smokers independent of antiretroviral therapy. AIDS. 2013;27(16):2603-14. DOI:10.1097/QAD.0b013e3283634819.

19. Peyracchia M., De Lio G., Montrucchio C., et al. Evaluation of coronary features of HIV patients presenting with ACS: The CUORE, a multicenter study. Atherosclerosis. 2018;274:218-26. DOI:10.1016/j.atherosclerosis.2018.05.001.

20. Raposeiras-Roubin S., Triant V. Ischemic Heart Disease in HIV: An In-depth Look at Cardiovascular Risk. Rev Esp Cardiol (Engl Ed). 2016;69(12):1204-13. DOI:10.1016/j.rec.2016.10.005.

21. Shah A.S.V., Stelzle D., Lee K.K., et al. Global Burden of Atherosclerotic Cardiovascular Disease in People Living With HIV. Circulation. 2018;138:1100-12. DOI:10.1161/CIRCULATIONAHA.117.033369.

22. Tarr P.E., Ledergerber B., Calmy A., et al. Subclinical coronary artery disease in Swiss HIV-positive and HIV-negative persons. Eur Heart J. 2018;39:2147-54. DOI:10.1093/eurheartj/ehy163.

23. Freiberg S.M., Chang C.H., Kuller L.H., et al. HIV Infection and the Risk of Acute Myocardial Infarction. JAMA Intern Med. 2013;173(8):614-22. DOI:10.1001/jamainternmed.2013.3728.

24. Gutierrez J., Albuquerque ALA., Falzon L. HIV infection as vascular risk: A systematic review of the literature and meta-analysis. PloS One. 2017;12(5):e0176686 DOI:10.1371/journal.pone.0176686.eCollection2017.

25. Boccara F., Mary-Krause M., Teiger E., et al. Acute coronary syndrome in HIV-infected patients: characteristics and 1 year prognosis. Eur Heart J. 2011;32(1):41-50. DOI:10.1093/eurheartj/ehq372.

26. Mestres C., Chuquiure J. E., Claramonte X., et al. Long-term results after cardiac surgery in patients infected with the human immunodeficiency virus type-1 (HIV-1). Eur J Cardiothorac Surg. 2003;23:1007-16. DOI:10.1016/s1010-7940(03)00162-3.

27. Lorgis L., Cottenet J., Molins G., et al. Outcomes after acute myocardial infarction in HIV-infected patients: analysis of data from a French nationwide hospital medical information database. Circulation. 2013;127(17):1767-74. DOI:10.1161/CIRCULATIONAHA.113.001874.

28. Hsue Y.P., Giri K., Erickson S., et al. Clinical Features of Acute Coronary Syndromes in Patients With Human Immunodeficiency Virus Infection. Circulation. 2004;109:316-9. DOI:10.1161/01.CIR.0000114520.38748.AA.

29. Busti A.J., Bain A.M., Hall R.G., et al. Effects of atazanavir/ritonavir or fosamprenavir/ritonavir on the pharmacokinetics of rosuvastatin. J Cardiovasc Pharmacol. 2008;51:605-10. DOI:10.1097/FJC.0b013e31817b5b5a.

30. Aberg J.A., Sponseller C.A., Ward D.J., et al. Pitavastatin versus pravastatin in adults with HIV-1 infection and dyslipidaemia (INTREPID): 12 week and 52 week results of a phase 4, multicentre, randomised, double-blind, superiority trial. Lancet HIV. 2017;4(7):e28-e294. DOI:10.1016/S2352-3018(17)30075-9.

31. Marsousi N., Daali Y., Fontana P., et al. Impact of Boosted Antiretroviral Therapy on the Pharmacokinetics and Efficacy of Clopidogrel and Prasugrel Active Metabolites. Clin Pharmacokinet. 2018;57(10):1347-54. DOI:10.1007/s40262-018-0637-6.

32. Triant V.A., Perez J., Regan S., et al. Cardiovascular Risk Prediction Functions Underestimate Risk in HIV Infection. Circulation. 2018;137(21):2203-14. DOI:10.1161/CIRCULATIONAHA.117.028975.

33. Kengne A.P., Ntsekhe M. Challenges of Cardiovascular Disease Risk Evaluation in People Living With HIV Infection. Circulation. 2018;137(21):2215-7. DOI:10.1161/CIRCULATIONAHA.118.033913.

34. Maggi P., Di Biagio A., Rusconi S., et al. Cardiovascular risk and dyslipidemia among persons living with HIV: a review. BMC Infectious Diseases. 2017;17:551. DOI:10.1186/s12879-017-2626-z.

35. Triant V.A. Cardiovascular Disease and HIV Infection. Curr HIV/AIDS Rep. 2013;10(3):199-206. DOI:10.1007/s11904-013-0168-6.


For citations:

Arzhakova M.A., Shekhovtsova T.A., Duplyakov D.V. Coronary Heart Disease in HIV-Infected Patients. Rational Pharmacotherapy in Cardiology. 2019;15(6):900-905. (In Russ.)

Views: 511

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.

ISSN 1819-6446 (Print)
ISSN 2225-3653 (Online)