Cardiovascular disease (CVD) rates are increased 50%-100% among people with HIV. The mechanisms of CVD in people with HIV include traditional risk factors such as smoking, dyslipidemia, diabetes mellitus (DM), and hypertension, and nontraditional risk factors specific to HIV also play a significant role. Indeed, increased CVD rates seen in large epidemiological studies have persisted after controlling for traditional risk factors. Multiple studies now demonstrate that HIV-related factors, including degree of immune dysfunction, nadir CD4 level, and inflammatory factors, contribute to increased CVD in people with HIV. Inflammatory factors may contribute, in part, through engendering the development of high-risk coronary atherosclerotic plaque, which is vulnerable to rupture and may result in myocardial infarction. Traditional CVD risk assessment algorithms, which do not incorporate inflammatory factors, have often underestimated risk among people with HIV, particularly in specific subgroups.
