HIV Cardiovascular Risk — SCE Infectious Diseases MCQ

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HardHIV MedicineHIV Cardiovascular RiskSCE Infectious Diseases

A 40-year-old man with HIV (CD4 650, VL <50 on ART for 8 years) asks about the long-term cardiovascular risk associated with HIV and ART. Which ART-associated factor has been most clearly linked to cardiovascular disease?

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Correct answer: C — HIV infection itself (chronic inflammation, immune activation) is the dominant cardiovascular risk factor — ART reduces but does not eliminate this excess risk

People living with HIV have approximately 1.5–2× excess cardiovascular risk compared to the general population. This is driven primarily by chronic HIV-associated inflammation and immune activation (elevated IL-6, D-dimer, sCD14, sCD163) that persists even with viral suppression. ART reduces but does not normalise this excess risk. Specific ART agents (formerly Abacavir — now removed from first-line; some PIs) have been associated with cardiovascular events, but the dominant driver is HIV itself. Comprehensive CVD risk management (statins, smoking cessation, BP control) is essential.

Reference: BHIVA 2025 – ART guidelines (cardiovascular section); EACS 2025 – CVD in HIV