HIV-1 Spectrum Disease, Psychological Distress, and Cardiometabolic Risk

A little more than a decade after the advent of highly active antiretroviral therapy (HAART), it is clear that the survival of HIV-infected individuals has substantially improved. However, with extended life span, there is increasing prevalence of chronic diseases, including obesity, type 2 diabetes mellitus, and atherosclerotic and arteriosclerotic diseases. In conjunction with the threat of mortality, HIV spectrum disease is associated with significant social stigma and numerous chronic stressors that are often unpredictable and uncontrollable, resulting in sustained elevations of negative affect and psychological distress. The psychoneuroimmunological literature indicates that psychological factors may deleteriously influence key aspects of immunological regulation, which could not only facilitate HIV disease severity but also exacerbate subclinical cardiometabolic pathophysiology. Indeed, the literature has noted an increased myocardial infarction risk in HIV/AIDS patients, especially since the introduction of HAART medications. Comorbid subclinical cardiometabolic conditions reminiscent of metabolic syndrome, as well as elevated blood pressure and vascular endothelial dysfunction, have been reported with increased prevalence in HIV-infected persons with HAART exposure. In addition to the depletion of CD4+ T-helper cells and a progressive decline in immune function, study findings indicate that the HIV infection promotes immune activation and heightened proinflammatory status.