Antiretroviral drugs and cardiovascular risk

Cardiovascular diseases (CVD) in human immunodeficiency virus (HIV)-infected patients are the result of amultifactorial interplay between the host, virus, and drug-related risk factors. Historically, first-generationantiretroviral therapy (ART) and particularly protease inhibitors (PIs) were blamed for a potential impact on CVrisk due to their implication in metabolic and body composition abnormalities. More recently, lopinavir andIndinavir cumulative exposure was associated with increased CV risk with a toxicity only partially explained bytheir metabolic impact. Concerns have also been raised regarding the potential CV risk associated withnucleoside reverse transcriptase inhibitors (NRTIs) and, particularly, with abacavir, but the potential mechanismsof this signal are not conclusive to provide a final answer. It is important to recognize that the magnitude ofincreased CV risk observed with these drugs is not high, especially as compared with the effect of other CVrisk factors and smoking, in particular. A tailoring approach to antiretroviral drug prescription must include theevaluation of patient global CV risk.