What happens to cardiovascular system behind the undetectable level of HIV viremia?
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AIDS Research and Therapy Open Access
REVIEW
What happens to cardiovascular system behind the undetectable level of HIV viremia? Gabriella d’Ettorre†, Giancarlo Ceccarelli*†, Paolo Pavone, Pietro Vittozzi, Gabriella De Girolamo, Ivan Schietroma, Sara Serafino, Noemi Giustini and Vincenzo Vullo
Abstract Despite the combined antiretroviral therapy has improved the length and quality of life of HIV infected patients, the survival of these patients is always decreased compared with the general population. This is the consequence of noninfectious illnesses including cardio vascular diseases. In fact large studies have indicated an increased risk of coronary atherosclerotic disease, myocardial infarction even in HIV patients on cART. In HIV infected patients several factors may contribute to the pathogenesis of cardiovascular problems: life-style, metabolic parameters, genetic predisposition, viral factors, immune activation, chronic inflammation and side effects of antiretroviral therapy. The same factors may also contribute to complicate the clinical management of these patients. Therefore, treatment of these non-infectious illnesses in HIV infected population is an emerging challenge for physicians. The purpose of this review is to focus on the new insights in non AIDS-related cardiovascular diseases in patients with suppressed HIV viremia. Keywords: Cardiovascular diseases, cARV, HIV, Premature aging A change of perspectives in the management of HIV infection: from an infectious disease to an internal medicine illness The introduction of potent combined antiretroviral therapy (cART) has dramatically increased the survival of HIV infected patients and has changed their causes of morbidity and mortality from AIDS-related opportunistic infections to serious non AIDS events (SNAEs) [1]. Currently achieving undetectable viral load has become the minimum objective achievable with antiretroviral therapy; otherwise the safety of the therapy, the reduction of residual viremia, the eradication of the virus from the reservoirs and the reduction of the process of immune activation and chronic inflammation are still challenges for scientific research. In particular to date is not well cleared the mechanisms for the establishment and maintenance of chronic immune activation. All available data suppose the presence of multiple and complex mechanisms *Correspondence: [email protected] † Gabriella d’Ettorre and Giancarlo Ceccarelli contributed equally to this work and should both be considered first authors Department of Public Health and Infectious Diseases, University of Rome “Sapienza”, Viale del Policlinico 155, Rome, Italy
acting synergistically and may contribute to the pathogenesis of SNAEs: viral factors, microbial translocation (MT), immune activation, systemic inflammation and side effects of therapy. Residual viremia, defined as the continuous persistence of the virus also at low levels despite effective cART, could be responsible of the chronic generalized inflammation and of the activation of the coagu
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