Antiretroviral therapy and cardiovascular risk: are some medications cardioprotective?

Overview

PURPOSE OF REVIEW: This review addresses the associations between coronary heart disease and antiretroviral medications, with a specific focus on medications that appear to have neutral or positive effects on coronary heart disease risk factors. RECENT FINDINGS: Studies have linked combination antiretroviral therapy with an increased risk of coronary heart disease. Often implicated are the effects of these medications on the metabolic risk factors for coronary heart disease, specifically lipids and glucose homeostasis. Many newer antiretrovirals have fewer metabolic side effects, and antiretrovirals in general may be cardioprotective by reducing inflammation. Whether use of specific antiretroviral regimens will translate into improved cardiovascular outcomes remains to be seen. SUMMARY: Some antiretrovirals appear to be at least neutral with regards to coronary heart disease risk, but it is not clear if any are truly cardioprotective. Nonetheless, it is prudent to consider regimens with limited metabolic side effects in patients with pre-established coronary heart disease risk.