The heart and HIV therapy: exploring the dual cardiovascular impact of antiretroviral treatment - a narrative review.

Human immunodeficiency virus (HIV) is a primary global health concern, affecting an estimated 38 million individuals as of 2023. While HIV is best known for its immunosuppressive effects, its cardiovascular implications are equally significant. HIV infection contributes to cardiovascular disease (CVD) through chronic immune activation, systemic inflammation, endothelial dysfunction, oxidative stress, and coagulopathy. These mechanisms increase the risk of myocardial infarction, cardiomyopathy, heart failure, pulmonary hypertension, and thrombotic events in people living with HIV (PLWH). However, the advent of Highly Active Antiretroviral Therapy (HAART) has transformed HIV from a fatal illness into a chronic, manageable condition. Despite this progress, HAART - particularly regimens involving protease inhibitors and certain nucleoside reverse transcriptase inhibitors - has introduced new cardiovascular challenges. These include dyslipidemia, insulin resistance, mitochondrial toxicity, and altered adipose tissue distribution, all of which further elevate cardiovascular risk. Additionally, HAART modifies immune and metabolic pathways, potentially exacerbating underlying HIV-associated cardiovascular mechanisms. Emerging research into microbial translocation and gut dysbiosis also points to complex interactions between HIV, HAART, and cardiovascular outcomes. As survival improves for PLWH, cardiologists and infectious disease specialists must collaborate to address both the direct effects of HIV and the unintended cardiovascular consequences of its treatment. The authors' review explores the dual impact of HIV and HAART on the cardiovascular system, emphasizing the importance of integrated care, early risk assessment, and therapeutic strategies tailored to the unique cardiovascular profile of PLWH.