HIV-pharmacotherapy and pathogenesis of diabetes-induced cardiovascular complications: an updated narrative review

Normal cardiac tissue glucose homeostasis is essential for the physiological function of the heart and the prevention of diabetic cardiomyopathies. The onset of diabetes mellitus has been reported to precede cardiovascular complications including cardiomyopathy, aortic stenosis, cardiac hypertrophy and hypertension. In addition to metabolic derangements, chronic medications such as HIV-antiretrovirals have also been associated with the risk factors of CVDs such as insulin resistance, dyslipidaemia, inflammation and oxidative stress and impaired glucose tolerance. Previous ART regimens have been associated with systemic insulin resistance and ectopic fat accumulation, leading to impaired glucose tolerance. The underlying molecular mechanisms behind the development of diabetic cardiomyopathies in persons chronically taking HIV-antiretrovirals remains unclear. Prediabetes is a condition of impaired glucose tolerance that is associated with low-grade inflammation and oxidative stress, which are precursors of CVDs. The link between chronic HIV-antiretroviral medication and prediabetes remains elusive. However, the increase in dispensation of HIV-antiretroviral medications has been associated with an increase in cases of prediabetes and diabetes, which could contribute to the development of CVDs. Hence, this review aims to provide insight into how the use of ARVs interacts with glucose metabolism and cardiovascular disease risk factors in patients on chronic HIV-antiretrovirals.