The Washington Post

Those living with HIV are more likely to face heart attacks, stroke, sudden cardiac death


People living with HIV are more likely to get heart disease than those without the virus, making it all the more critical they 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 new scientific statement from the American Heart Associatio­n published in the journal 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 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 result . . . is 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 United States 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, such as smoking and eating poorly. About 42 percent 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 Paul Volberding, director of the AIDS Research Institute at the University of California at 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.”

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