With the advancement in efficacy and tolerability of HIV treatments, individuals with HIV are living longer and longer. However, despite HIV viral load suppression (undetectable), those with HIV have a higher risk of heart disease. According to a recent statement from the American Heart Association (AHA), “Rates of myocardial infarction, heart failure, stroke, and other CVD manifestations, including pulmonary hypertension and sudden cardiac death, are significantly higher for people living with HIV than for uninfected control subjects, even in the setting of HIV viral suppression with effective antiretroviral therapy.” Alarmingly, it is estimated the risk of heart disease is a 1.5 to 2.0-fold increase in people living in HIV when compared to HIV-negative individuals.
Why is there an increase in Cardiovascular Disease with PLWH (People living with HIV)?
Researchers believe it is, at least, partly attributable to chronic inflammation and immune dysregulation caused by HIV, even in the presence of viral load suppression. Other possible attributing factors include increased lipids associated with certain HIV medications, behavioral factors like smoking, and disparities in access to healthcare among PLWH.
What can PLWH do to reduce their risk of cardiovascular disease?
The best approach PLWH can take is to live a healthy lifestyle. This includes eating a healthy, well-balanced diet, exercising regularly, and not smoking. This also includes moderating alcohol intake.
There is a lack of research on how to treat and prevent cardiovascular disease in PLWH. More research is needed to determine exactly what steps clinicians should take to help their patients live longer, healthier lives. Taking HIV meds that suppress viral load is also crucial in lowering risks of heart disease. Unsuppressed viral loads and lower CD4 counts are associated with high risks of heart disease in PLWH.
Diabetes and hypertension increase one’s risk of heart disease, so PLWH who have either condition should ensure these conditions are controlled with lifestyle changes and the appropriate medication regimens.
What can my medical provider do to help me lower this risk?
Statins, which are cholesterol-lowering medications, could play a pivotal role in decreasing heart disease risk among PLWH. According to this recent article published by Dr. Feinstein and his colleagues from Northwestern University, “In addition to statin therapy, other strategies to potentially reduce CVD risk in HIV include antithrombotic agents (like aspirin), which may be underused in HIV but have not yet been assessed in prospective studies powered to evaluate CVD events.”
If you are someone living with HIV, speak to one of our primary care providers who specialize in HIV about how to lower your risk of heart disease.
Jeremiah Robinson is a licensed and certified Physician Assistant at T. Douglas Gurley MD in Atlanta, GA.