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Although associated with some alterations of lipid metabolism and development of lipodystrophy, combination antiretroviral therapy (cART) abrogated infections in patients with HIV and improved the quality and expectancy of life.1 This therapeutic success has allowed the recognition of an association between HIV infection and cardiovascular diseases.2,3 Long-lived patients with HIV exhibited a marked acceleration of atherosclerosis with an increased risk of acute ischemic events.3,4 Thus, long-term cardiovascular comorbidities might weaken the relative immune defense benefits induced by cART. It remains unclear if cART directly increases cardiovascular risk or if virus-derived compounds could be responsible for atherogenesis. For instance, recent evidence from clinical trials suggested that viral replication rebound during interruption of cART may provoke a rapid increase of serum levels of cardiovascular risk biomarkers as well as of clinical cardiovascular events.2,5 Recent results from the Veterans Aging Cohort Study–Virtual Cohort demonstrated an increased risk of cerebral disease, including ischemic stroke, in HIV-positive patients.6 On the other hand, the Framingham Risk Score for Stroke prediction systematically underestimates the long-term risk of stroke in HIV-positive men, suggesting that many unknown factors might influence the pathophysiology in the cerebral circulation in HIV.7
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See page 1139
- © 2015 American Academy of Neurology
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