HIV patients face premature heart ailment and barriers to care

A new study has claimed that people living with HIV are at a higher risk of heart and blood vessel ailments compared to people without HIV.

According to the study published in the journal 'Circulation,' the risk arises due to interactions between traditional risk factors, such as diet, lifestyle and tobacco use, and HIV-specific risk factors, such as a chronically activated immune system and inflammation characteristic of chronic HIV.

Tobacco use, a major risk factor for cardiovascular diseases, is common among people living with HIV. In a nationally representative United States sample, 42 per cent of people living with HIV were current smokers.

Heavy alcohol use, substance abuse, mood and anxiety disorders, low levels of physical activity and poor cardiorespiratory fitness are also common among people living with HIV and may contribute to elevated risk for diseases of the heart and blood vessels, according to the study.

"Considerable gaps exist in our knowledge about HIV-associated diseases of the heart and blood vessels, in part because HIV's transition from a fatal disease to a chronic condition is relatively recent, so long-term data on heart disease risks are limited," said Matthew J. Feinstein, University of Chicago.

In addition, people living with HIV are often stigmatised and face significant barriers to optimal health care, such as education level, where they live, healthcare literacy, disenfranchisement from the healthcare system, cognitive impairment, injection drug use, internalised and anticipated stigma, gait and mobility impairment, frailty, depression and social isolation. There are also disparities in care based on age, race, ethnicity, and gender.

Another area of concern is the ageing population of people living with HIV - 75 per cent of people living with HIV are over age 45. "Aging with HIV differs greatly from the ageing issues facing the general population," said Jules Levin, MS, in an accompanying patient perspective.

"On average, people living with HIV who are over 60 years old have 3-7 medical conditions, including heart attacks, strokes, heart failure, kidney disease, frailty and bone diseases and many take 12-15 medications daily," said Levin.

Providing scientifically based recommendations on how to reduce the risk of cardiovascular disease among people living with HIV is also challenging.

To assess a person living with HIV's cardiovascular risk, the study advised a nuanced approach. This approach includes quantifying traditional heart disease risk factor burden using tools such as American Heart Association/American College of Cardiology Atherosclerotic Disease Risk Calculator, which estimates a person's ten-year risk of having a heart attack, stroke or other cardiovascular condition, as a starting point.

However, the authors caution that people living with HIV may have a higher risk than indicated by the calculator.

To keep people living with HIV healthy, Feinstein emphasised the importance of a healthy lifestyle that includes smoking cessation, adequate physical activity, eliminating or reducing the amount of alcohol consumed and a healthy diet.

In addition, medications such as statin drugs, which lower cholesterol, and other medications that make blood less likely to form clots may be helpful, although more clinical trial data are needed.