Studies published before the introduction of highly active antiretroviral therapy (HAART) tracked the incidence and course of HIV infection in relation to cardiac illness in both children and adults. These studies show that subclinical echocardiographic abnormalities independently predict adverse outcomes and identify high-risk groups to be targeted for early intervention and therapy. The introduction of HAART has altered cardiovascular manifestations in HIV. On the one hand, HAART has significantly modified the course of HIV disease, lengthened survival, and improved the quality of life of HIV-infected patients. On the other hand, the early data have raised concerns that HAART is associated with an increase in both peripheral and coronary arterial diseases, creating an intriguing clinical scenery. This book focuses on new clinical and biological insight related to HIV-associated metabolic and cardiovascular complications in the HAART era.
Never in the history of humanity has knowledge progressed as quickly as in the field of AIDS. Over a period of 15 years, successive discoveries of the disease, its viral origin, the virus responsible, its physiopathology and highly effective therapies have led to spectacular improvement in life expectancy and in the quality of life of people who have access to these treatments.
However, this progress in therapy has been accompanied by initially unforeseeable anomalies, such as abnormalities in lipid and glucose metabolism and modifications in fat distribution, particularly in perivisceral and trunkal accumulation as well as pseudo-obesity usually accompanied by peripheral atrophy.
Several of these anomalies constitute risk factors for cardiovascular diseases and may be predictors of these diseases. Over time, most investigators have come to accept that HIV-infected patients are at an increased risk for cardiovascular complications.
