Source: everydayhealth.com
HIV-positive people are living longer than ever because of therapies that prevent the growth of the virus. But these patients deal with more heart troubles and barriers to treatment than other individuals, according to the American Heart Association (AHA).
A scientific statement published in June 2019 in the journal Circulation highlighted that three-quarters of people over the age of 45 who are living with HIV are experiencing significantly more heart attacks, heart failure, and strokes earlier in life compared with those who don’t have HIV.
“Chronic inflammation and immune activation [or response] appear to be the primary drivers of high heart disease risk in HIV,” says Matthew Feinstein, MD, chair of the writing group for the statement and assistant professor of medicine and preventive medicine at the Feinberg School of Medicine at Northwestern University in Chicago.
He stresses that HIV treatment is essential, not only for controlling the virus, but also for reducing chronic inflammation and problems with immune regulation.
“Several studies have now shown that worse HIV control is associated with higher risks for heart disease,” Dr. Feinstein told Everyday Health. “So the first and most important step in preventing heart disease in HIV is getting the HIV under control with the right medications prescribed by HIV specialists and primary care doctors.”
Addressing Common Heart Disease Factors
The statement authors also observed that people living with HIV more often had factors commonly associated with heart troubles, such as heavy alcohol use, substance abuse, mood and anxiety disorders, low levels of physical activity, and poor cardiorespiratory fitness.
About 4 out of 10 are smokers, according to a nationally representative sample of HIV patients.
Quitting tobacco use, eating a balanced diet (such as the DASH diet or Mediterranean diet), and staying physically active can help lower risk, notes Feinstein.
Sarah Samaan, MD, a cardiologist with Baylor Scott & White Legacy Heart Center in Plano, Texas, who was not an author on the statement, has seen many HIV patients benefit from statin drugs to lower cholesterol and medication to lower blood pressure.
“Since some HIV medications can raise the risk of side effects from other drugs, it’s important to discuss the options for treatment with a knowledgeable physician,” say Dr. Samaan. “A good pharmacist can also help to ensure that the drugs that are prescribed are safe and appropriate.”
Living Longer But With More Health Problems
In an accompanying patient perspective published by the American Heart Association, Jules Levin, the founder and executive director of the National AIDS Treatment Advocacy Project (NATAP), expressed his concerns about the high numbers of serious medical problems in older people with HIV compared with the general population.
According to NATAP, those with HIV over 60 years old have an average of three to seven health conditions in addition to being HIV-positive. Comorbidities include heart attacks, strokes, heart failure, kidney disease, frailty, and bone diseases. Also, many take 12 to 15 drugs daily.
“Most people don’t know that HIV is causing accelerated aging,” says Levin, who has been living with HIV for 35 years. “Within a few years of initial infection, the immune system senescence [deterioration with age] sets in right away. Once people with HIV get into their sixties, they really have a double hit — from aging and from the effects of HIV.”
This is why Levin urges HIV-positive individuals to be screened for cardiovascular troubles as well as bone density, kidney disease, and cognitive impairment.
The scientific statement recommends trying the American Heart Association–American College of Cardiology Atherosclerotic Disease Risk Calculator as one way for getting some idea of your heart disease risk.
Overcoming Barriers to Treatment
Both Feinstein and Levin spotlight the need for improving access to healthcare for people living with HIV. The statement authors pointed out that this population is often stigmatized, and federal and local authorities could make more effort to increase care options for these individuals. Many living with HIV are homebound and cognitively impaired to a degree where they have difficulties paying bills and making decisions.
“What’s most needed are support services and better care in the clinics,” says Levin. “We need to actively demand that federal and local officials address this problem.”
He urges people to contact NATAP to explore ways to take action.
A Call for Further Research
Feinstein and his coauthors based this scientific statement on large observational studies investigating HIV and heart disease.
“But we don’t yet have much in the way of large-scale randomized trial data for heart disease prevention and treatment in HIV,” he says. “Although we have a reasonable understanding of why plaque buildup in the arteries occurs in HIV, we do not have as clear of an understanding of why the heart muscle often becomes dysfunctional or why blood clotting may occur more commonly in HIV.”