IJCS | Volume 31, Nº5, September / October 2018

DOI: 10.5935/2359-4802.20180049 538 REVIEW ARTICLE International Journal of Cardiovascular Sciences. 2018;31(5)538-543 Mailing Address: Hugo Ribeiro Zanetti Universidade Federal de Uberlândia (UFU) - Avenida Pará, 1720. Postal Code: 38400-902, Bairro Umuarama, Uberlândia, MG -Brazil E-mail: hugo.zanetti@hotmail.com Cardiovascular Complications of HIV Hugo Ribeiro Zanetti, Leonardo Roever, Alexandre Gonçalves, Elmiro Santos Resende Universidade Federal de Uberlândia (UFU), Uberlância, MG - Brazil Manuscript received June 29, 2017; revised manuscript October 05, 2017; accepted November 17, 2017. Ca r d i ova s cu l a r Di s e a s e s ; HIV ; Ac qu i r ed Immunodeficiency Syndrome; Acute Retroviral Syndrome/therapy; Inflammation Mediators. Keywords Abstract With the advent of the antiretroviral therapy (ART), people infected with HIV are experiencing a significant increase in life expectancy. However, as this population ages, the morbidity and mortality due to events not related to HIV infection and/or treatment become increasingly clear. Cardiovascular diseases are among the major causes of death, and, thus, understanding the factors that trigger this situation is necessary. This review article will assess how the intrinsic and extrinsic factors related to HIV, ART and the associated risk factors can aid the epidemiological transition of mortality in this population. Moreover, we will present the studies on the epidemiology and pathogenesis of each clinical condition related to HIV-infected individuals, in addition to introducing the major markers of cardiovascular disease in this population. Finally, we will point the main issues to be addressed by health professionals for an adequate prognosis. Introduction Since the first case reported, HIV infection has become a worldwide public health problem. Over 36 million people are estimated to be infected with HIV, and approximately 1.1 million deaths were attributed to that infection in 2015. In addition, by the end of 2015, more than 2.1 million new cases were identified. 1 Pharmacological strategies have been created aimed at reducing HIV replication in infected individuals. The pharmacological intervention was monotherapy with zidovudine (AZT), which inhibits the action of reverse transcriptase. 2 Later, in the mid-1990s, antiretroviral therapy (ART) was introduced, significantly changing the course of HIV infection, with consequent increase in the life expectancy and quality of life of infected individuals. Although essential to treat HIV infection, ART is associated with several side effects. The most studied impairments are those related to the metabolism of glucose and lipids, and the lipodystrophy syndrome. 3,4 This set of changes has affected the mortality of those individuals. Previous studies have confirmed that their causes of death are associated with diseases not related to HIV, but to ART. 5 The major causes are neoplasms and cardiovascular diseases. This review was aimed at summarizing the studies on cardiovascular diseases and their risk factors in HIV- infected people. Cardiovascular diseases in HIV-infected people Traditional cardiovascular risk factors are known to be directly related to mortality in the general population. 6 In HIV-infected people, some risk factors, such as smoking habit and use of illicit drugs, can be more frequent than in the non-infectedpopulation. 7,8 In addition, the infectionper se can pose a higher risk of cardiovascular disease because of the adverse effects of the continuous use of ART. 9,10 One of the major characteristics of the relationship between HIV and cardiovascular disease is the higher carotid intima-media thickness. This condition of subclinical atherosclerosis is directly associated with modifiable risk factors, except for the male sex. 11 One possible explanation for that characteristic is associated with ART effects on the lipidmetabolism, with increased LDL-c, triglycerides and total cholesterol. 12 Regarding the modifiable risk factors and mortality in HIV-infected people, the smoking habit, arterial