Effective antiretroviral (ARV) regimens for the treatment of HIV

Effective antiretroviral (ARV) regimens for the treatment of HIV infection have increased life expectancy, and many individuals Sunitinib molecular weight infected with HIV now live for decades with chronic illness [1]. Long-term complications are emerging as the greatest challenges facing HIV-infected individuals. Atherosclerotic cardiovascular disease (CVD) is a leading comorbidity and cause of mortality among HIV-infected adults [2]. Several studies have shown that HIV-infected children, compared with their healthy peers, have higher rates of CVD risk factors, including dyslipidaemia, insulin resistance, obesity

and central adiposity [3-7]. HIV infection also results in prolonged chronic inflammation, thereby increasing CVD risk. Exogenous obesity, which is common among perinatally HIV-infected children and adolescents, can also contribute to CVD risk [8, 9]. For perinatally infected children, these exposures

start in utero and continue through critical periods of growth, puberty and development. Inflammation, which is now considered the primary mechanism leading to atherosclerosis, can initiate a complex sequence of events that eventually produce buy ABT-263 detectable arterial changes and symptomatic CVD [10]. A host of cellular pathways are activated through inflammation, with most being initiated through injury to the endothelium [10]. Factors associated with endothelial injury include oxidized cholesterol, hyperglycaemia, lifestyle (smoking), and familial/genetic risks [11]. In HIV-infected patients, the effects of chronic immune activation from HIV infection [12, 13] and potential oxidative stress (induced by mitochondrial dysfunction) caused by highly active antiretroviral therapy (HAART) also come into play [14, 15]. These factors initiate a cascade of events that can increase inflammation and produce changes in endothelial function and/or coagulation status. Although HIV-infected children carry risk factors that

are associated with premature atherosclerotic crotamiton CVD, it is currently difficult to ascertain whether the adverse CVD outcomes attributed to HIV infection in adults will be observed as HIV-infected children age. Emerging evidence from large, long-term and prospective studies on CVD risk in non-HIV-infected healthy children [16, 17] shows that risk factors tracked from early childhood are associated with adverse CVD outcomes in adulthood. Studies that show direct evidence of vascular inflammation may provide further proof of increased CVD risk that, in turn, may ultimately lead to new, preventive interventions for these children. C-reactive protein (CRP) is one of the best-studied measures of systemic inflammation and high levels can predict adverse CVD outcomes in adults [18]. A number of other biomarkers are associated with more specific changes in these inflammatory pathways in both HIV-infected and HIV-uninfected populations [19-21].

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