Living with HIV means increased risk of heart disease

(Reuters Health) - People living with HIV are more likely to get heart disease than those without the virus, making it all the more critical they do things like exercise, eat well, and avoid smoking, U.S. doctors say.

In recent decades, antiretroviral therapy has helped transform the human immunodeficiency virus (HIV) from a near-certain death sentence into a chronic, manageable disease. As HIV patients are living longer, however, they’re also at higher risk for heart attacks, strokes, heart failure, sudden cardiac death and other diseases than people without HIV, according to a scientific statement from the American Heart Association (AHA) published in Circulation.

“Even when the virus is controlled such that it is not detectable by routine blood tests, there remains an HIV reservoir in certain tissues of the body which leads to chronic immune system activation and inflammation,” said Dr. Matthew Feinstein of the Northwestern University Feinberg School of Medicine in Chicago, lead author of the statement.

“This chronic immune activation and inflammation can, over time, lead to plaque buildup in the arteries of the heart and blood vessels, and possibly more blood clotting and problems with the heart muscle itself,” Feinstein said by email. “The more heart attacks, strokes, and heart failure due to problems with the heart muscle’s ability to squeeze and/or relax.”

Three of every four people living with HIV in the U.S. today are over age 45, and they face a variety of health challenges at earlier ages than individuals without the disease, the statement says.

Complicating matters, people living with HIV may also be more apt to have certain risk factors for heart disease like smoking and eating poorly. About 42% of people with HIV smoke, for example.

Other risk factors for heart disease that are more common among people with HIV include heavy alcohol use, drug misuse and mood and anxiety disorders.

Many people living with HIV face stigma and challenges accessing and affording care, according to the statement. Barriers can include poverty, inadequate health insurance, limited education, depression, social isolation as well as discrimination based on gender identity, sexual orientation, race or ethnicity.

While these barriers are a problem even without HIV, the added heart disease risk with HIV makes it crucial to modify any risk factors that are within patients’ control, doctors say.

“As HIV has become a chronic disease, addressing the problems that may be increased in the setting of HIV, including higher rates of cardiovascular disease, is an important aspect of comprehensive HIV care,” said Dr. Paul Volberding, director of the AIDS Research Institute at the University of California, San Francisco.

“It is important for clinicians to assess these risks and to work with the patient to prevent bad outcomes by lifestyle changes and in some cases medical interventions,” Volberding, who wasn’t involved in the statement, said by email. “The biggest modifiable risks are smoking, a lack of regular exercise, obesity and elevated blood lipid levels.”

To assess their cardiovascular risk, people with and without HIV can start with a free online tool, according to the statement. One option is a calculator from the AHA and the American College of Cardiology that estimates a person's 10-year risk of events like heart attack or stroke (

However, people living with HIV may have a higher risk than indicated by the calculator, the statement notes, because of unique risk factors such as a long wait to start antiretroviral therapy once they’re diagnosed with HIV.

To keep people with HIV healthy, Feinstein emphasizes 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, patients should take any drugs needed to maintain healthy blood pressure and cholesterol levels.

SOURCE: Circulation, online June 3, 2019.