{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:40:29Z","timestamp":1760035229793,"version":"build-2065373602"},"reference-count":86,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2025,6,25]],"date-time":"2025-06-25T00:00:00Z","timestamp":1750809600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Viruses"],"abstract":"<jats:p>Atherosclerosis remains a leading cause of mortality globally, and this is worse in people living with HIV (PLHIV). While the administration of antiretroviral therapy (ART) in this population has significant benefits, it is essential to acknowledge that it also has some undesired effects. This study investigated the impact of ART on carotid intima-media thickness (CIMT) in PLHIV as a marker of early atherosclerosis. A literature search was conducted on the PubMed, Scopus, and EBSCOhost databases from 1 January 1987 to 30 May 2025. The methodological quality of the studies was assessed using the Newcastle\u2013Ottawa scale. Data were analyzed using a meta-analysis web tool and reported as the mean difference (MD) and 95% confidence intervals (CIs). Twenty-seven studies, which included 3250 PLHIV on ART and 1542 who were ART-naive, were relevant. The mean age was 41.26 in ART and 39.91 years. The results showed a higher CIMT in PLHIV on ART compared to the ART-naive group, MD = 0.03 mm, 95% CI (0.02 mm to 0.04 mm), p &lt; 0.0001; I2 = 96.9%. Subgroup analysis showed that the inclusion of studies conducted on male participants only, those with a sample size of one hundred, and those with a moderate risk of bias contributed to heterogeneity. The results suggest there is an increased risk of atherosclerosis in PLHIV on ART.<\/jats:p>","DOI":"10.3390\/v17070894","type":"journal-article","created":{"date-parts":[[2025,7,2]],"date-time":"2025-07-02T07:55:43Z","timestamp":1751442943000},"page":"894","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Association Between HIV Infection and Carotid Intima-Media Thickness in the Era of Antiretroviral Therapy: A Meta-Analysis"],"prefix":"10.3390","volume":"17","author":[{"given":"Angelina","family":"Nieuwoudt","sequence":"first","affiliation":[{"name":"Department of Life and Consumer Sciences, College of Agriculture and Environmental Sciences, University of South Africa, Roodepoort 1710, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kay-Lee E.","family":"Strauss","sequence":"additional","affiliation":[{"name":"Department of Life and Consumer Sciences, College of Agriculture and Environmental Sciences, University of South Africa, Roodepoort 1710, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7769-4528","authenticated-orcid":false,"given":"Wendy N.","family":"Phoswa","sequence":"additional","affiliation":[{"name":"Department of Life and Consumer Sciences, College of Agriculture and Environmental Sciences, University of South Africa, Roodepoort 1710, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3224-7433","authenticated-orcid":false,"given":"Kabelo","family":"Mokgalaboni","sequence":"additional","affiliation":[{"name":"Department of Life and Consumer Sciences, College of Agriculture and Environmental Sciences, University of South Africa, Roodepoort 1710, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,6,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e279","DOI":"10.1016\/S2352-3018(20)30036-9","article-title":"HIV and Cardiovascular Disease","volume":"7","author":"Benjamin","year":"2020","journal-title":"Lancet HIV"},{"key":"ref_2","unstructured":"(2024, May 10). HIV. Available online: https:\/\/www.who.int\/data\/gho\/data\/themes\/hiv-aids."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Ntinga, X., Musiello, F., Pita, T., Mabaso, N., Celum, C., Szpiro, A., van Rooyen, H., Barnabas, R., and van Heerden, A. (2024). People Living with HIV\u2019s Perspectives of Acceptability of Fee for Home Delivery of ART: A Qualitative Study. BMC Health Serv. Res., 24.","DOI":"10.1186\/s12913-023-10533-4"},{"key":"ref_4","first-page":"e47730","article-title":"The Impact of Contemporary Antiretroviral Drugs on Atherosclerosis and Its Complications in People Living With HIV: A Systematic Review","volume":"15","author":"Vemulapalli","year":"2023","journal-title":"Cureus"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"275","DOI":"10.2174\/157016207780077084","article-title":"Epicardial Adipose Tissue Is Related to Carotid Intima-Media Thickness and Visceral Adiposity in HIV-Infected Patients with Highly Active Antiretroviral Therapy-Associated Metabolic Syndrome","volume":"5","author":"Lacobellis","year":"2007","journal-title":"Curr. HIV Res."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1603","DOI":"10.1161\/01.CIR.0000124480.32233.8A","article-title":"Progression of Atherosclerosis as Assessed by Carotid Intima-Media Thickness in Patients with HIV Infection","volume":"109","author":"Hsue","year":"2004","journal-title":"Circulation"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2201","DOI":"10.1097\/QAD.0b013e32833d2132","article-title":"Associations of Antiretroviral Drug Use and HIV-Specific Risk Factors with Carotid Intima\u2013Media Thickness","volume":"24","author":"Delaney","year":"2010","journal-title":"AIDS"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1016\/j.thromres.2023.12.011","article-title":"Endothelial Dysfunction, a Predictor of Cardiovascular Disease in HIV Patients on Antiretroviral Therapy: A Systematic Review and Meta-Analysis","volume":"234","author":"Strauss","year":"2024","journal-title":"Thromb. Res."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"155547","DOI":"10.1016\/j.cyto.2021.155547","article-title":"Descriptive Modification of Inflammatory Markers in HIV Patients after CART Initiation According to Gender, Smoking Habit, CMV Infection, BMI and Serum Lipids","volume":"143","author":"Zanella","year":"2021","journal-title":"Cytokine"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"The DAD Study Group (2007). Class of Antiretroviral Drugs and the Risk of Myocardial Infarction. N. Engl. J. Med., 356, 1723\u20131735.","DOI":"10.1056\/NEJMoa062744"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"467","DOI":"10.1097\/QAD.0000000000003373","article-title":"Recent Abacavir Use and Incident Cardiovascular Disease in Contemporary-Treated People with HIV","volume":"37","author":"Jaschinski","year":"2023","journal-title":"AIDS"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Adedokun, T.A., Kwaghe, V.G., Adedokun, O., Badru, T., Odili, A.N., Alfa, J., Kolade-Yunusa, H.O., and Ojji, D.B. (2023). Prevalence and Risk Factors for Subclinical Atherosclerosis amongst Adults Living with HIV in University of Abuja Teaching Hospital, Gwagwalada. Front. Reprod. Health, 5.","DOI":"10.3389\/frph.2023.1092211"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e2018099","DOI":"10.1001\/jamanetworkopen.2020.18099","article-title":"Association of Viral Persistence and Atherosclerosis in Adults with Treated HIV Infection","volume":"3","author":"Mclaughlin","year":"2020","journal-title":"JAMA Netw. Open"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Hyle, E.P., Mayosi, B.M., Middelkoop, K., Mosepele, M., Martey, E.B., Walensky, R.P., Bekker, L.G., and Triant, V.A. (2017). The Association between HIV and Atherosclerotic Cardiovascular Disease in Sub-Saharan Africa: A Systematic Review. BMC Public Health, 17.","DOI":"10.1186\/s12889-017-4940-1"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1089\/aid.2012.0015","article-title":"Two-Year Treatment with Rosuvastatin Reduces Carotid Intima-Media Thickness in HIV Type 1-Infected Patients Receiving Highly Active Antiretroviral Therapy with Asymptomatic Atherosclerosis and Moderate Cardiovascular Risk","volume":"29","author":"Calza","year":"2013","journal-title":"AIDS Res. Hum. Retroviruses"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1495","DOI":"10.1097\/QAD.0000000000001109","article-title":"Inflammation, Immune Activation, and Cardiovascular Disease in HIV","volume":"30","author":"Nou","year":"2016","journal-title":"AIDS"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Vos, A.G., Dodd, C.N., Delemarre, E.M., Nierkens, S., Serenata, C., Grobbee, D.E., Klipstein-Grobusch, K., and Venter, W.D.F. (2021). Patterns of Immune Activation in HIV and Non HIV Subjects and Its Relation to Cardiovascular Disease Risk. Front. Immunol., 12.","DOI":"10.3389\/fimmu.2021.647805"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"720","DOI":"10.1016\/j.atherosclerosis.2006.12.022","article-title":"Both Long-Term HIV Infection and Highly Active Antiretroviral Therapy Are Independent Risk Factors for Early Carotid Atherosclerosis","volume":"196","author":"Lorenz","year":"2008","journal-title":"Atherosclerosis"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1177\/0956462420972854","article-title":"Prevalence and Risk of Subclinical Carotid Atherosclerosis in the Global Population with HIV: A Systematic Review and Meta-Analysis","volume":"32","author":"Liu","year":"2021","journal-title":"Int. J. STD AIDS"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"52","DOI":"10.4103\/ijstd.ijstd_72_21","article-title":"Effect of Antiretroviral Therapy on Cardiac Risk Markers in People Living with HIV\/AIDS","volume":"43","author":"Gupta","year":"2022","journal-title":"Indian J. Sex. Transm. Dis. AIDS"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"107812","DOI":"10.1161\/JAHA.119.013466","article-title":"Cardiovascular Disease Burden in Rural Africa: Does Hiv and Antiretroviral Treatment Play a Role?","volume":"9","author":"Vos","year":"2020","journal-title":"J. Am. Heart Assoc."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e19554","DOI":"10.1097\/MD.0000000000019554","article-title":"Carotid Intima Media Thickness in Older Children and Adolescents with HIV Taking Antiretroviral Therapy","volume":"99","author":"Majonga","year":"2020","journal-title":"Medicine"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"87","DOI":"10.5334\/gh.1264","article-title":"Prevalence and Determinants of Endothelial Dysfunction among Adults Living with HIV in Northwest Nigeria","volume":"18","author":"Nalado","year":"2023","journal-title":"Glob. Heart"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"123186","DOI":"10.1016\/j.jns.2024.123186","article-title":"Lack of Impact of HIV Status on Carotid Intima Media Thickness in a Cohort of Stroke Patients in South Africa","volume":"465","author":"Sadiq","year":"2024","journal-title":"J. Neurol. Sci."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1016\/j.atherosclerosis.2022.05.013","article-title":"The Effect of Perinatal HIV and Antiretroviral Therapy on Vascular Structure and Function in Young People: A Systematic Review and Meta-Analysis","volume":"352","author":"Majonga","year":"2022","journal-title":"Atherosclerosis"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"116851","DOI":"10.1016\/j.lfs.2019.116851","article-title":"The Effect of HIV Infection, Antiretroviral Therapy on Carotid Intima-Media Thickness: A Systematic Review and Meta-Analysis","volume":"235","author":"Msoka","year":"2019","journal-title":"Life Sci."},{"key":"ref_27","first-page":"1","article-title":"The PRISMA 2020 Statement: An Updated Guideline for Reporting Systematic Reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_28","unstructured":"(2024, September 15). Why the HIV Epidemic Is Not Over. Available online: https:\/\/www.who.int\/news-room\/spotlight\/why-the-hiv-epidemic-is-not-over."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"276","DOI":"10.11613\/BM.2012.031","article-title":"Interrater Reliability: The Kappa Statistic","volume":"22","author":"McHugh","year":"2012","journal-title":"Biochem. Med."},{"key":"ref_30","unstructured":"Wells, G., Shea, B., O\u2019Connell, D., Peterson, J., Welch, V., Losos, M., and Tugwell, P. (2024, November 19). The Newcastle-Ottawa Scale (NOS) for Assessing the Quality If Nonrandomized Studies in Meta-Analyses. Available online: http:\/\/www.ohri.ca\/programs\/clinical_epidemiology\/oxford.asp."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Hozo, S.P., Djulbegovic, B., and Hozo, I. (2005). Estimating the Mean and Variance from the Median, Range, and the Size of a Sample. BMC Med. Res. Methodol., 5.","DOI":"10.1186\/1471-2288-5-13"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1539","DOI":"10.1002\/sim.1186","article-title":"Quantifying Heterogeneity in a Meta-Analysis","volume":"21","author":"Higgins","year":"2002","journal-title":"Stat. Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"522","DOI":"10.1002\/jrsm.1414","article-title":"Funnel Plots May Show Asymmetry in the Absence of Publication Bias with Continuous Outcomes Dependent on Baseline Risk: Presentation of a New Publication Bias Test","volume":"11","author":"Doleman","year":"2020","journal-title":"Res. Synth. Methods"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1136\/bmj.315.7109.629","article-title":"Bias in Meta-Analysis Detected by a Simple, Graphical Test","volume":"315","author":"Egger","year":"1997","journal-title":"BMJ"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"f4040","DOI":"10.1136\/bmj.f4040","article-title":"Meta-Analyses: Heterogeneity and Subgroup Analysis","volume":"346","author":"Sedgwick","year":"2013","journal-title":"BMJ"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1091","DOI":"10.1111\/rssc.12440","article-title":"Sensitivity Analysis for Publication Bias in Meta-Analyses","volume":"69","author":"Mathur","year":"2020","journal-title":"J. R. Stat. Soc. Ser. C Appl. Stat."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"e64016","DOI":"10.2196\/64016","article-title":"MetaAnalysisOnline.Com: Web-Based Tool for the Rapid Meta-Analysis of Clinical and Epidemiological Studies","volume":"27","author":"Fekete","year":"2025","journal-title":"J. Med. Internet Res."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Moshomo, T., Molefe-Baikai, O.J., Bennett, K., Gaolathe, T., Moyo, S., Gaseitsewe, S., Mohammed, T., Lockman, S., and Mosepele, M. (2024). Cytomegalovirus Immunoglobulin G Levels and Subclinical Arterial Disease among People Living with HIV in Botswana: A Cross-Sectional Study. Biomedicines, 12.","DOI":"10.3390\/biomedicines12050935"},{"key":"ref_39","first-page":"1","article-title":"Evaluation of Differences in Metabolic and Immunologic Markers and Cardiovascular Risk in Hiv-1 Patients","volume":"19","author":"Castro","year":"2021","journal-title":"Rev. Cienc. Salud"},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Kirichenko, T.V., Myasoedova, V.A., Shimonova, T.E., Melnichenko, A.A., Sviridov, D., Sobenin, I.A., Mazus, A.I., Orekhov, A.N., and Bukrinsky, M.I. (2018). Atherosclerosis in Subjects Newly Diagnosed with Human Immunodeficiency Virus Infection. Biosci. Rep., 38.","DOI":"10.1042\/BSR20180597"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1016\/j.atherosclerosis.2015.03.015","article-title":"Endothelial Activation and Cardiometabolic Profiles of Treated and Never-Treated HIV Infected Africans","volume":"240","author":"Fourie","year":"2015","journal-title":"Atherosclerosis"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1097\/QAD.0000000000000539","article-title":"Increased Carotid Intima-Media Thickness Is Not Associated with T-Cell Activation nor with Cytomegalovirus in HIV-Infected Neversmoker Patients","volume":"29","author":"Goulenok","year":"2015","journal-title":"AIDS"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"496","DOI":"10.1016\/j.bjid.2014.02.007","article-title":"Long-Term Use of First-Line Highly Active Antiretroviral Therapy Is Not Associated with Carotid Artery Stiffness in Human Immunodeficiency Virus-Positive Patients","volume":"18","author":"Zhu","year":"2014","journal-title":"Braz. J. Infect. Dis."},{"key":"ref_44","first-page":"261","article-title":"The Evaluation of Carotid Atherosclerosis in Patients with the HIV-1 Infection: The Role of the Antiretroviral Therapy","volume":"7","author":"Suparna","year":"2013","journal-title":"J. Clin. Diagn. Res."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"2603","DOI":"10.1097\/QAD.0b013e3283634819","article-title":"Infection Duration and Inflammatory Imbalance Are Associated with Atherosclerotic Risk in HIV-Infected Never-Smokers Independent of Antiretroviral Therapy","volume":"27","author":"Desvarieux","year":"2013","journal-title":"AIDS"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1007\/s11547-010-0591-3","article-title":"Valutazione Ecografica Delle Lesioni Vascolari Carotidee Nei Pazienti HIV Positivi","volume":"116","author":"Cristofaro","year":"2011","journal-title":"Radiol. Medica"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1097\/QAI.0b013e31819367cd","article-title":"Carotid Intima-Media Thickness and Arterial Stiffness in HIV-Infected Patients: The Role of HIV, Antiretroviral Therapy, and Lipodystrophy","volume":"50","author":"Smulders","year":"2009","journal-title":"J. Acquir. Immune Defic. Syndr."},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Di Yacovo, S., Saumoy, M., S\u00e1nchez-Quesada, J.L., Navarro, A., Sviridov, D., Javaloyas, M., Vila, R., Vernet, A., Low, H., and Pe\u00f1afiel, J. (2020). Lipids, Biomarkers, and Subclinical Atherosclerosis in Treatment-Naive HIV Patients Starting or Not Starting Antiretroviral Therapy: Comparison with a Healthy Control Group in a 2-Year Prospective Study. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0237739"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1016\/j.jns.2018.12.026","article-title":"Burden of Subclinical Carotid Atherosclerosis and Vascular Risk Factors among People Living with HIV in Ghana","volume":"397","author":"Sarfo","year":"2019","journal-title":"J. Neurol. Sci."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"108069","DOI":"10.1016\/j.maturitas.2024.108069","article-title":"The Association of Menopause with Cardiometabolic Disease Risk Factors in Women Living with and without HIV in Sub-Saharan Africa: Results from the AWI-Gen 1 Study","volume":"187","author":"Chikwati","year":"2024","journal-title":"Maturitas"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1186\/s12977-019-0497-7","article-title":"Cardiovascular Disease Risk in an Urban African Population: A Cross-Sectional Analysis on the Role of HIV and Antiretroviral Treatment","volume":"16","author":"Vos","year":"2019","journal-title":"Retrovirology"},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Gleason, R.L., Caulk, A.W., Seifu, D., Parker, I., Vidakovic, B., Getenet, H., Assefa, G., and Amogne, W. (2015). Current Efavirenz (EFV) or Ritonavir-Boosted Lopinavir (LPV\/r) Use Correlates with Elevate Markers of Atherosclerosis in HIV-Infected Subjects in Addis Ababa, Ethiopia. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0117125"},{"key":"ref_53","first-page":"1000167","article-title":"Carotid Intima-Media Thickness in African Patients with Critical Lower Limb Ischemia Infected with the Human Immunodeficiency Virus","volume":"3","author":"Brand","year":"2012","journal-title":"J. AIDS Clin. Res."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1007\/s00508-014-0516-6","article-title":"Early Atherosclerosis in HIV-Infected Patients below the Age of 55 Years: Slovenian National Study","volume":"126","author":"Pirs","year":"2014","journal-title":"Wien. Klin. Wochenschr."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"683","DOI":"10.1258\/ijsa.2009.008504","article-title":"Cardiovascular Risk Factors and Ultrasound Evaluation of Carotid Atherosclerosis in Patients with HIV-1 Infection","volume":"20","author":"Calza","year":"2009","journal-title":"Int. J. STD AIDS"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"1788","DOI":"10.1093\/infdis\/jis276","article-title":"Cytomegalovirus Immunoglobulin G Antibody Is Associated with Subclinical Carotid Artery Disease among HIV-Infected Women","volume":"205","author":"Parrinello","year":"2012","journal-title":"J. Infect. Dis."},{"key":"ref_57","first-page":"6442","article-title":"Comparison of CIMT among HIV Seropositive and HIV Seronegative Subjects: A Case-Control Study","volume":"6","author":"Vohra","year":"2017","journal-title":"Int. J. Curr. Adv. Res."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1016\/S0021-9150(01)00736-5","article-title":"Assessment of Atherosclerosis Using Carotid Ultrasonography in a Cohort of HIV-Positive Patients Treated with Protease Inhibitors","volume":"162","author":"Seminari","year":"2002","journal-title":"Atherosclerosis"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"1","DOI":"10.2174\/1876818001102010001","article-title":"HIV Disease, Antiretroviral Therapy Safety and the Cardiovascular System. Clinical-Instrumental Assessment of Antiretroviral-Na\u00efve Versus Subjects Already Treated with Antiretroviral Agents","volume":"2","author":"Manfredi","year":"2011","journal-title":"Open Drug Saf. J."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1016\/S2055-6640(20)30237-5","article-title":"Markers of Subclinical Atherosclerotic Disease in HIV-Infected Individuals","volume":"4","author":"Gupta","year":"2018","journal-title":"J. Virus Erad."},{"key":"ref_61","first-page":"1","article-title":"Study of Cardiovascular Risks and Carotid Intimal Thickness (CIMT) And The Effect Of Antiretroviral Therapy In The Cardiovascular Profile Among HIV Patients","volume":"14","author":"Joseph","year":"2025","journal-title":"Int. J. Sci. Res."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"759","DOI":"10.29271\/jcpsp.2021.07.759","article-title":"The Value of Carotid Intima-Media Thickness in the Detection of Atherosclerosis in HIV+ Patients Subclinical Atherosclerosis in HIV+","volume":"31","author":"Ozdemir","year":"2021","journal-title":"J. Coll. Physicians Surg. Pak."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"1636","DOI":"10.1093\/cid\/ciz442","article-title":"Antiretroviral Therapy Reduces T-Cell Activation and Immune Exhaustion Markers in Human Immunodeficiency Virus Controllers","volume":"70","author":"Li","year":"2020","journal-title":"Clin. Infect. Dis."},{"key":"ref_64","doi-asserted-by":"crossref","unstructured":"Strauss, K.-L.E., Phoswa, W.N., and Mokgalaboni, K. (2024). The Impact of Antiretroviral Therapy on Liver Function Among 2 HIV Infected Pregnant Women with and Without Pre-Eclampsia. Viruses, 17.","DOI":"10.3390\/v17010028"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"1515","DOI":"10.1161\/CIRCRESAHA.124.323891","article-title":"Inflammation in HIV and Its Impact on Atherosclerotic Cardiovascular Disease","volume":"134","author":"Obare","year":"2024","journal-title":"Circ Res"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"3084","DOI":"10.1016\/j.jacc.2017.05.012","article-title":"HIV-1\u2013Associated Atherosclerosis: Unraveling the Missing Link","volume":"69","author":"Kearns","year":"2017","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1186\/s12947-015-0041-4","article-title":"Causes of Changes in Carotid Intima-Media Thickness: A Literature Review","volume":"13","author":"Qu","year":"2015","journal-title":"Cardiovasc. Ultrasound"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"100130","DOI":"10.1016\/j.ajpc.2020.100130","article-title":"Inflammation and Cardiovascular Disease: From Mechanisms to Therapeutics","volume":"4","author":"Alfaddagh","year":"2020","journal-title":"Am. J. Prev. Cardiol."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"8852","DOI":"10.3390\/cimb46080523","article-title":"ROS Chronicles in HIV Infection: Genesis of Oxidative Stress, Associated Pathologies, and Therapeutic Strategies","volume":"46","author":"Harshithkumar","year":"2024","journal-title":"Curr. Issues Mol. Biol."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"103","DOI":"10.14740\/jem364w","article-title":"Highly Active Antiretroviral Therapy-Associated Metabolic Syndrome and Lipodystrophy: Pathophysiology and Current Therapeutic Interventions","volume":"7","author":"Nzuza","year":"2017","journal-title":"J. Endocrinol. Metab."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1097\/COH.0000000000000755","article-title":"HIV and Cardiovascular Disease: The Role of Inflammation","volume":"17","author":"Funderburg","year":"2022","journal-title":"Curr. Opin. HIV AIDS"},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1093\/cid\/ciw697","article-title":"Very Early ART and Persistent Inflammation in Treated HIV","volume":"64","author":"Hunt","year":"2017","journal-title":"Clin. Infect. Dis."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"1447","DOI":"10.1210\/er.2018-00141","article-title":"Insulin Resistance and Atherosclerosis: Implications for Insulin-Sensitizing Agents","volume":"40","author":"Defronzo","year":"2019","journal-title":"Endocr. Rev."},{"key":"ref_74","doi-asserted-by":"crossref","unstructured":"The RESPOND Study Group (2021). Incidence of Dyslipidemia in People with HIV Who Are Treated with Integrase Inhibitors versus Other Antiretroviral Agents. AIDS, 35, 869\u2013882.","DOI":"10.1097\/QAD.0000000000002811"},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1172\/JCI200316261","article-title":"HIV Protease Inhibitors Promote Atherosclerotic Lesion Formation Independent of Dyslipidemia by Increasing CD36-Dependent Cholesteryl Ester Accumulation in Macrophages","volume":"111","author":"Dressman","year":"2003","journal-title":"J. Clin. Investig."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"724","DOI":"10.1021\/acs.molpharmaceut.8b01014","article-title":"Targeted Mitochondrial COQ 10 Delivery Attenuates Antiretroviral-Drug-Induced Senescence of Neural Progenitor Cells","volume":"16","author":"Velichkovska","year":"2019","journal-title":"Mol. Pharm."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1186\/s12981-024-00694-5","article-title":"Di Factors Associated with Oxidative Stress in Virologically Suppressed People Living with HIV on Long-Term Antiretroviral Therapy","volume":"21","author":"Lombardi","year":"2024","journal-title":"AIDS Res. Ther."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"8910396","DOI":"10.1155\/2016\/8910396","article-title":"Oxidative Stress during HIV Infection: Mechanisms and Consequences","volume":"2016","author":"Ivanov","year":"2016","journal-title":"Oxid. Med. Cell Longev."},{"key":"ref_79","doi-asserted-by":"crossref","unstructured":"Alikhani, A., Morin, H., Matte, S., Alikhani, P., Tremblay, C., and Durand, M. (2019). Association between Lipodystrophy and Length of Exposure to ARTs in Adult HIV-1 Infected Patients in Montreal. BMC Infect. Dis., 19.","DOI":"10.1186\/s12879-019-4446-9"},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"1548","DOI":"10.4102\/sajhivmed.v25i1.1548","article-title":"Inflammatory Mechanisms Contributing to Retinal Alterations in HIV Infection and Long-Term ART","volume":"25","author":"Buthelezi","year":"2024","journal-title":"S. Afr. J. HIV Med."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1097\/COH.0000000000000702","article-title":"Cardiovascular Toxicity of Contemporary Antiretroviral Therapy","volume":"16","author":"Vos","year":"2021","journal-title":"Curr. Opin. HIV AIDS"},{"key":"ref_82","doi-asserted-by":"crossref","unstructured":"Babu, H., Ambikan, A.T., Gabriel, E.E., Akusj\u00e4rvi, S.S., Palaniappan, A.N., Sundaraj, V., Mupanni, N.R., Sperk, M., Cheedarla, N., and Sridhar, R. (2019). Systemic Inflammation and the Increased Risk of Inflamm-Aging and Age-Associated Diseases in People Living with HIV on Long Term Suppressive Antiretroviral Therapy. Front. Immunol., 10.","DOI":"10.3389\/fimmu.2019.01965"},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"677","DOI":"10.5551\/jat.37895","article-title":"Associations of Cardiovascular Risk Factors with Carotid Intima-Media Thickness in Middle-Age Adults and Elders","volume":"24","author":"Wu","year":"2017","journal-title":"J. Atheroscler. Thromb."},{"key":"ref_84","doi-asserted-by":"crossref","unstructured":"Vickhoff, B. (2023). Why Art? The Role of Arts in Arts and Health. Front. Psychol., 14.","DOI":"10.3389\/fpsyg.2023.765019"},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"e051173","DOI":"10.1136\/bmjopen-2021-051173","article-title":"Preferences for Group Arts Therapies: A Cross-Sectional Survey of Mental Health Patients and the General Population","volume":"11","author":"Millard","year":"2021","journal-title":"BMJ Open"},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"3334","DOI":"10.1093\/jac\/dkaa292","article-title":"Switching from Boosted PIs to Dolutegravir in HIV-Infected Patients with High Cardiovascular Risk: 48 Week Effects on Subclinical Cardiovascular Disease","volume":"75","author":"Assoumou","year":"2020","journal-title":"J. Antimicrob. Chemother."}],"container-title":["Viruses"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1999-4915\/17\/7\/894\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:58:17Z","timestamp":1760032697000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1999-4915\/17\/7\/894"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,25]]},"references-count":86,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2025,7]]}},"alternative-id":["v17070894"],"URL":"https:\/\/doi.org\/10.3390\/v17070894","relation":{},"ISSN":["1999-4915"],"issn-type":[{"type":"electronic","value":"1999-4915"}],"subject":[],"published":{"date-parts":[[2025,6,25]]}}}