A Review on the Disease Risk and Contemporary Management of Peripheral Arterial Disease in the HIV Population

Abstract

Background The development of highly active antiretroviral therapy (HAART) for patients with human immunodeficiency virus (HIV) has improved life expectancy resulting in increased longevity. Consequently, the prevalence of peripheral arterial disease (PAD) in this population has continued to rise, while HAART has been shown to be an independent risk factor for the development of accelerated atherosclerosis, thereby complicating management strategies. The aim of this study was to investigate the literature for trends and contemporary outcomes of lower extremity revascularization among patients with HIV and PAD. Methods A narrative review of full text articles evaluating PAD outcomes in patients with HIV from inception to 2024 was performed. Results Contemporary management of PAD in the HIV population has demonstrated improvements in understanding disease pathophysiology, including the impact HAART medications have on PAD development and determining which patients were benefit from intervention. While patients with HIV and PAD tend to be younger, they are more likely to undergo an open surgical bypass or primary in-hospital major amputation resulting in longer hospitalization and higher cost burden. Lower extremity revascularization in this population appears to be safe, with acceptable patient-related outcomes, particularly in the asymptomatic patients with low viral loads and acceptable CD4 counts. Conclusion PAD prevalence in patients with HIV is growing, compounded by longer life expectancy with HAART medications. Lower extremity revascularization has demonstrated important utility to benefit patients with PAD and HIV with a wide range of influence. Further studies are needed to assess long-term outcomes after revascularization.