Persistent inflammation linked to HIV and antiretroviral therapy (ART) is increasingly recognized as a driver of atherosclerotic cardiovascular disease (ASCVD), according to recent research.
The connection between HIV, ART, and cardiovascular health has become more apparent as individuals with HIV live longer, thanks to advancements in treatment. A study published in Current Opinion in HIV and AIDS in September 2023, detailed the role of inflammation in the development of ASCVD in people with HIV (PWH). Researchers Sahera Dirajlal-Fargo and Nicholas Funderburg, affiliated with Rainbow Babies and Children’s Hospital and Case Western Reserve University, along with The Ohio State University, found that immune activation persists even in individuals undergoing ART. Markers of inflammation, such as interleukin-6 (IL-6) and C-reactive protein, are predictive of mortality in this population.
The research highlights several underlying mechanisms contributing to chronic inflammation in PWH, including clonal hematopoiesis, trained immunity, and alterations in lipidomics. These factors contribute to accelerated ASCVD.
Prevalence of moderate to severe coronary disease among people living with HIV ranges from 0% to 52%, while myocardial fibrosis is observed in 5% to 84% of cases, according to a report in JAMA Network from September 13, 2022. This underscores the significant cardiovascular risk faced by this population.
Cells of both the innate and adaptive immune systems contribute to both systemic and vascular inflammation, as detailed in research published in May 2024 by the American Heart Association. This complex interplay of immune responses plays a crucial role in the progression of cardiovascular disease in individuals with HIV.
Further research is ongoing to fully elucidate the mechanisms driving inflammation and ASCVD in PWH, with Nicholas Funderburg, PhD, at The Ohio State University, leading investigations into these immunologic processes.
