Antiretroviral therapy has dramatically increased the life span of HIV patients. Despite this, people living with HIV experience other devastating illnesses, such as cardiovascular disease (CVD), at a significant rate. Cardiovascular diseases and related conditions often seen in people living with HIV include coronary artery disease, heart attack, pulmonary hypertension, heart failure and stroke.
HIV increases the risk of suffering a heart attack or stroke by 50-100% percent. CVD is often thought of as an age related disease. In the general population, the rate of CVD increases with age, growing more prevalent once a person reaches over 50 years of age. However, an increased CVD risk is seen among people with HIV as young as 40. Women experience CVD more often than men, with those who may be considered at low risk in the general population considered at high risk among HIV- positive people.
Symptoms of CVD may include dizziness, fatigue, difficulty breathing, nausea, indigestion, heartburn or stomach pain. However, some people experience no symptoms to alert them to the development of cardiovascular disease (CVD).
Risk factors for heart disease include the more typical risks, such as smoking, family history, high cholesterol and a sedentary lifestyle. However, other factors have been identified that are directly related to HIV. These include increased immune activation and inflammation. Low level but persistent activation of the immune system is recognized as a major issue for people living with HIV that can contribute not only to CVD but to bone disease, liver disease, neurological conditions and cancers. High viral load has also been linked to CVD and early treatment is recommended to decrease damage caused by viral reproduction.
People living with HIV are encouraged to live healthy lifestyles and to minimize their risk factors for heart disease. A healthy diet, smoking cessation and regular exercise are all thought to decrease the risk of CVD.
Statins have been proven effective among HIV negative people to treat heart disease and can be used prophylactically, in some cases. The same effect may be achieved among HIV- positive people. A large clinical trial called the REPREIVE study aims to determine statins are both effective and tolerated in the long term among people with HIV. The results may alter treatment and care to promote early detection, risk reduction and the course of treatment of CVD to reduce morbidity and mortality among the HIV population.
by Anil Singh