Cardiovascular disease continues to be the leading cause of death among the general population of industrialized countries.
It is also the main reason for hospitalization. But what about HIV-infected subjects? With the advent of combination antiretroviral therapy (cART) for HIV infection, including protease inhibitors (PIs), in April 1996 in France, the morbidity of AIDS-defining illnesses has been reduced and HIV-infected patients are living longer [1, 2].
Thus, the spectrum of diseases related to HIV is shifting from opportunistic diseases towards long-term complications such as cancers, coinfection with other viruses such as hepatitis C virus, and the metabolic effects of cART. Some of these disorders are potential risk factors for cardiovascular diseases and so could lead to cardiovascular over-mortality and over-morbidity. Cardiovascular diseases currently account for 7% of deaths among HIV-infected subjects in France, for 14% of non-HIV-related deaths [3], and about 16% of deaths among subjects with a good immunovirologic response to cART [4].Defined as any combination of at least three antiretroviral drugs -usually two nucleoside analog reverse transcriptase inhibitors (NRTI) and either a PI or a nonnucleoside reverse transcriptase inhibitor (NNRTI)- cART is the current reference standard of antiretroviral treatment [5, 6]. The adverse effects of cART have received much attention in recent years. Although lipid disorders were described in HIV- infected patients before the advent of cART [7, 8], several class-specific metabolic effects of cART may have a deleterious impact on the heart, including increased insulin resistance, hypercholesterolemia and/or hypertriglyceridemia, and lipodystrophy syndromes [9-12]. Likewise, although coronary lesions were described well before the advent of PIs [13, 14], cART has been implicated in the aggravation of coronary heart diseases (CHD) and in other vascular complications [15-20]. However, even if most of studies were in favor of the impact of the PIs, especially myocardial infarction (MI), concerning the risk of CHD, this impact remains controversial. The increased rate of MI has been linked to PI by some studies, others have shown a link to HIV disease with limited data on treatment.