Metabolic and cardiovascular complications of HIV

Prior to the advent of highly active antiretroviral therapy, patients with advanced HIV disease presented with cardiovascular complications such as dilated cardiomyopathy and pericardial effusions. HIV is now a manageable chronic disease with patients more likely to present with complications related to treatment including coronary artery disease, diabetes, dyslipidaemia, lipodystrophy and osteopaenia. While complications, such as lactic acidosis, have become uncommon, others such as pulmonary hypertension have remained constant despite effective therapy. Attempts to mitigate exposure to potentially toxic drugs have revealed that the virus itself also has important pro-inflammatory effects.