HIV-Associated Vascular Disease and Endothelial Injury
With the advent of more effective therapies for human immunodeficiency virus (HIV) infection, HIV-infected patients are living longer; therefore HIV-associated disease and complications of antiviral therapy are becoming a significant concern in this population. HIV infection has been associated with the development of endocarditis, myocarditis, pericardial effusions, and dilated cardiomyopathy. Clinical use of HIV protease inhibitors has been associated with metabolic alteration and increased risk for cardiovascular disease. This chapter focuses on HIV-associated vascular disease and endothelial injury. Clinical investigations and possible mechanisms of atherosclerosis, pulmonary hypertension, and thrombosis in HIV-infected patients are discussed. Recent advances in molecular understandings of HIV-associated endothelial injury-including direct HIV infection, expression of cytokines and adhesion molecules, apoptosis, and endothelial permeability-are also discussed. Endothelial injury or dysfunction may contribute significantly to the pathogenesis of vascular disease in HIV-infected patients.