Atherosclerosis in HIV-positive patients is clearly multifactorial in origin and ensues from traditional cardiac risk factors, HIV itself, and antiretroviral therapy. However, the absolute risk of cardiovascular events among HIVinfected patients remains low and must be balanced against the remarkable benefits from HAART in terms of improvement in immune function and related morbidity and mortality.
Preliminary guidelines regarding pharmacological therapy of metabolic alterations associated with HAART can be made from a limited number of studies. Moreover, the benefit of aggressive management of hyperlipidaemia and diabetes must be balanced with the risk of additional medications, potential drug interactions, additional pill burden, compromise in patient adherence, and potential compromise of optimal HIV infection control. Further, prospective studies with adequate design (including accuracy of collected data, prospective ascertainment of endpoints, and enough length of follow-up) are certainly needed in order to better investigate the association between HIV disease and myocardial infarction and to define specific guidelines for the management of HIV-related cardiovascular risk.