The use of new potent
protease inhibitor-based antiretroviral
therapies in patients with human immunodeficiency virus (
HIV) infection has been increasingly associated with cardiovascular risk factors, including hyperlipidaemia, fat redistribution syndrome,
insulin resistance, and
diabetes mellitus. The introduction of
highly active antiretroviral therapy (
HAART) in clinical practice has remarkably changed the natural history of HIV disease, leading to a notable extension of life expectancy, and prolonged
lipid and
glucose metabolism abnormalities are expected to lead to significant effects on the long-term prognosis and outcome of HIV-infected patients. Prediction modeling,
surrogate markers and hard cardiovascular endpoints suggest an increased incidence of
cardiovascular diseases in HIV-infected subjects receiving
HAART, even though the absolute risk of cardiovascular complications remains still low, and must be balanced against the evident virological, immunological, and clinical benefits descending from
combination antiretroviral therapy. Nevertheless, the assessment of cardiovascular risk should be performed on regular basis in HIV-positive individuals, especially after initiation or change of antiretroviral treatment. Appropriate lifestyle measures (including smoking cessation, dietary changes, and aerobic physical activity) are critical points, and switching
HAART may be considered, although maintaining viremic control should be the main goal of
therapy. Pharmacological treatment of dyslipidaemia (usually with
statins and
fibrates), and hyperglycaemia (with
insulin-sensitizing agents and
thiazolidinediones), becomes suitable when lifestyle modifications and switching
therapy are ineffective or not applicable.