Antiretroviral-Induced Metabolic Dysregulation: Pathways and Long-Term Cardiovascular Risk in HIV

Ernest Nsubuga

Department of Clinical Pharmacy Kampala International University Uganda

Email: ernest.nsubuga@studwc.kiu.ac.ug

                                                                         ABSTRACT
The introduction of combination antiretroviral therapy has transformed human immunodeficiency virus infection from a fatal disease into a chronic, manageable condition, resulting in a substantial increase in life expectancy among affected individuals. However, this epidemiological success had been accompanied by a growing burden of metabolic complications and cardiovascular disease. The purpose of this review was to critically examine the molecular and biochemical pathways underlying antiretroviral-induced metabolic dysregulation and to elucidate their contribution to long-term cardiovascular risk in people living with HIV. This narrative review was developed through comprehensive analysis and synthesis of current experimental, translational, and clinical literature on antiretroviral
therapy and cardiometabolic outcomes. Evidence indicated that mitochondrial dysfunction, oxidative stress, adipocyte impairment, altered insulin signaling, dyslipidemia, chronic immune activation, and endothelial dysfunction collectively mediate atherogenic processes in treated HIV populations. Specific antiretroviral classes exerted differential metabolic effects, further modulating cardiovascular risk profiles. Longitudinal cohort data demonstrated increased incidence of myocardial infarction, subclinical atherosclerosis, and arterial stiffness in this population. Early risk stratification and mechanistically informed therapeutic strategies are therefore essential. Integrated cardiometabolic monitoring and individualized antiretroviral selection were critical to reducing longterm cardiovascular morbidity in HIV.

Keywords: HIV, antiretroviral therapy, Metabolic dysregulation, Cardiovascular disease, Mitochondrial dysfunction.

CITE AS: Ernest Nsubuga (2026). Antiretroviral-Induced Metabolic Dysregulation: Pathways and Long-Term Cardiovascular Risk in HIV. IDOSR JOURNAL OF APPLIED SCIENCES 11(2):71-76.
https://doi.org/10.59298/IDOSRJAS/2026/1127176