Cardiovascular disease management and prevention: the new frontier in the management of patients with human immunodeficiency virus infection.

In the era of highly effective antiretroviral therapy (ART), management of chronic human immunodeficiency virus (HIV) infection has shifted towards the management of chronic co-morbid disease. Cardiovascular diseases (CVDs) including myocardial infarction and ischaemic stroke disproportionately affect people with HIV (PWH), impacting morbidity and mortality, even despite effective viral load suppression with ART. The mechanisms underlying this are incompletely understood but involve a complex interplay of traditional cardiovascular risk factors, chronic inflammation and metabolic side effects of ART. Due to unique disease features, currently available tools for the assessment of cardiovascular risk in the general population perform inconsistently in PWH. Although the optimal strategy for primary and secondary prevention remains unclear, it is important to identify high-risk patients and consider the interplay between HIV infection, ART and atherosclerotic disease. Recent trials have shed light on interventions such as early initiation of statin therapy, which can mitigate systemic inflammation and improve cardiovascular outcomes. We present a comprehensive review of the prevalence and development of CVD in HIV together with an evidence-based, recommended approach to management.