Guidelines for the prevention of cardiovascular risk in HIV-Infected patients treated with antiretroviral drugs

Highly active antiretroviral therapy (HAART) has decreased by two-thirds [1] the lethality of AIDS and opportunistic infections. However, the improved survival of HIV patients receiving HAART has become associated with metabolic complications including insulin resistance, impaired glucose tolerance, loss of skeletal muscle mass (sarcopenia) and performance, osteopenia, lipid abnormalities such as dyslipidemia and body-fat distribution [2-19], which increase cardiovascular morbidity, compromising the patient's quality of life and the efficacy of HAART. As a consequence of prolonged survival and the direct effect of HAART [16], AIDS is changing from a slim disease to a lipodystrophic disease [20] and the care of the HIV-infected patients has shifted from prevention and treatment of opportunistic infections and malignancies to management of the metabolic and related complications[17]. The risk of cardiovascular disease (CVD) in HIV patients is increased two- to three-fold by disturbances in fat metabolism [15, 17]. New strategies addressed to prevent and manage such emerging disorders, including muscle and bone disorders (sarcopenia and osteopenia) [17, 21, 22], are needed. Moreover, coronary heart disease (CHD) is the leading cause of death and a common cause of morbidity in Western countries. Approximately 14 million Americans have CHD, according to NHANES III data [23]. Annually, about 1.1 million of them experience a heart attack and about 500,000 die from CHD (Fig. 1).