Endothelial dysfunction in HIV infection

Highly active antiretroviral therapy (HAART) has signi ficantly improved the prognosis of patients with HIV infection; however, the use of protease inhibitors has been associated with increased cardiovascular events and worsening of multiple coronary heart disease risk factors including dyslipidemia, insulin resistance, and endothelial dysfunction. Endothelial dysfunction may be caused by the infection itself, the immunologic responses due to the HIV virus, and also by the effects of HAART through their effects on both lipid and glucose metabolism. The study of endothelial function in HIV infection and its modifications by HAART is an exciting new field in clinical research, limited by multiple factors such as viral factors, immunologic conditions, and metabolic drug effects that could affect the interpretation of endothelial impairment. Further studies are still needed to understand the significance of endothelial dysfunction in the cardiovascular risk assessment of patients with HIV infection.