HIV patients at increased risk of heart disease, stroke

Patients with HIV are at a significantly higher risk of suffering from heart and blood vessel diseases as compared to those without the infection, scientists say.

According to a new scientific statement published in the journal Circulation, effective antiretroviral therapy has changed HIV from a progressive, fatal disease to a chronic, manageable condition that increases the risk of heart attacks and strokes.

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 contribute to the increased risk of heart and blood vessel diseases in HIV patients.

Tobacco use, a major risk factor for cardiovascular diseases, is common among people living with HIV.

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 statement.

"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, from Northwestern University in the US.

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, cognitive impairment, 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.

"Ageing with HIV differs greatly from the aging issues facing the general population," said Jules Levin, 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.

"As they age, people living with HIV are often alone and disabled, emotionally homebound due to depression, and are socially isolated," he added.

"In addition, they often suffer from lack of mobility and an impaired ability to perform normal daily functions," he said.

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

"There is a dearth of large-scale clinical trial data on how to prevent and treat cardiovascular diseases in people living with HIV. This is an area of research that is needed for informed decision-making and effective CVD prevention and treatment in the ageing population of people living with HIV," said Feinstein.