State of the Science Conference
Authors: Steven K. Grinspoon, Carl Grunfeld, Donald P. Kotler, Judith S. Currier, Jens D. Lundgren, Michael P. Dubé, Steven E. Lipshultz, Priscilla Y. Hsue, Kathleen Squires, Morris Schambelan, Peter W.F. Wilson, Kevin E. Yarasheski, Colleen M. Hadigan, James H. Stein, Robert H. Eckel
Journal: Circulation (2008)

W ith successful antiretroviral therapy, patients infected with the human immunodeficiency virus (HIV) are living longer; however, recent reports suggest increased rates of coronary heart disease (CHD) among HIV-infected patients, 1 and cardiovascular disease has become an important cause of morbidity and mortality in this population. 2Increased CHD rates in the HIV population may relate to traditional risk factors, including advancing age, higher smoking rates, dyslipidemia, insulin resistance, and impaired glucose tolerance.Cardiovascular disease may also be due to nontraditional factors, including changes in body composition with loss of subcutaneous fat and/or accumulation of visceral fat in some patients, inflammation, and direct effects of the virus on the vasculature, as well as to direct effects of specific antiretroviral drugs.Important questions remain as to the pathogenesis, detection, and treatment of cardiovascular disease and related risk factors in HIV-infected patients.These questions concern, among other things, the design of adequate trials to determine CHD incidence and the utility of existing CHD guidelines for screening, prevention, treatment, and risk stratification.To ascertain the state of the science with respect to these and related questions, a multidisciplinary conference with interested HIV specialists, cardiologists, endocrinologists, primary care physicians, National Institutes of Health representatives, and patient advocates was convened June 28 -30, 2007, in Chicago, Ill, and chaired by Drs Steven Grinspoon and Robert Eckel.The discussions focused on 6 areas of interest, each with its own working group, including the following: (1) the contribution of metabolic and anthropometric abnormalities to cardiovascular disease risk factors (chaired by Drs Carl Grunfeld and Donald Kotler); (2) the epidemiological evidence for cardiovascular disease and its relationship to highly active antiretroviral therapy (HAART; chaired by Drs Judy Currier and Jens Lundgren); (3) the effects of HIV infection and antiretroviral therapy on the heart and vasculature (chaired by Drs Michael Dubé and Steve Lipshultz); (4) the screening and assessment of CHD in HIV-infected patients (chaired by Drs Priscilla Hsue and Kathleen Squires); (5) the development of appropriate CHD risk prediction models in HIV-infected patients (chaired by Drs Morris Schambelan, Kevin Yarasheski, and Peter Wilson); and (6) prevention strategies for CHD in HIV-infected patients (chaired by Drs James Stein and Colleen Hadigan).For each area of interest, specific topics were covered in plenary lectures and in subsequent discussions with conference participants.Summaries for each working group were reported to the conference participants for discussion (indi-The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel.Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest.