Emerging Clinical Problem of Resistance to Antiplatelet Therapy in Primary Prevention and Treatment of Cardiovascular Events in People Living with HIV: Conundrum despite Effective cART

Abstract

Despite the extensive use of combined antiretroviral therapy (cART) for effective human immunodeficiency viral (HIV) suppression, people living with HIV have an increased risk of cardiovascular events compared to the general population. Antiplatelet agents are recommended for primary prevention and treatment of individuals at risk of ischaemic stroke and heart attack. However, these guidelines and recommendations are hinged on data from non-HIV populations. Accumulating evidence has revealed that response to antiplatelet agents varies in people living with HIV compared to non-HIV individuals. The variability may be attributed to consequences of HIV infection, metabolic derangements, and effects of cART and other drug interactions. Given that interventions employed in primary and secondary prevention of cardiovascular events heavily rely on guidelines developed for the general population that emphasize on identification, optimization and stratification of traditional risk factors, there is need to tailor these interventions with knowledge of HIV status and co-administration of cART. This chapter will synthesize the current topic regarding antiplatelet agents in people living with HIV. Specifically, we will critically examine the effects of individual antiplatelet agents on platelet function tests, drug interactions with cart and clinical data on the reduction of cardiovascular events.