Patients with HIV could benefit from cardiovascular disease prevention strategies

The projected cumulative incidence of cardiovascular disease among patients living with HIV was significantly higher than that of people without HIV, study data showed.

The findings prompted researchers to suggest that CVD risk should be included in treatment evaluation for patients with HIV.

“Due to major advances in the treatment of HIV disease, the life expectancy of treatment-adherent people living with HIV is approaching that of the general population,” Elena Losina, PhD, of the Medical Practice Evaluation Center, Boston, and colleagues wrote. “Aging [people living with HIV] and their health care providers now face new challenges related to prevention and treatment of common chronic conditions, including cardiovascular disease. While numerous studies have focused on the increased risk of CVD in [people living with HIV] as evidenced by abnormal biomarkers of chronic inflammation and abnormal lipid metabolism, these studies have not estimated lifetime CVD risk at the population level.”

Losina and colleagues projected the cumulative incidence of CVD in the general population, people who were not infected but at risk for HIV and patients living with HIV, using a mathematical model. The researchers incorporated the higher prevalence of smoking and consequential CVD risk in the HIV–infected and at-risk populations, as well as HIV–attributable CVD risk independent of smoking.

Overall, life expectancy was 70.2 years for men with HIV, compared with 77.5 years for the general population, and 67 years for women with HIV vs. 81.1 years in the general population. The CVD risk for men with HIV who were not undergoing ART was 12.9%, whereas in women, the lifetime risk was 9%, the researchers wrote. By age 60, the cumulative CVD incidence in men living with HIV was an estimated 20.5%, whereas in men at high risk for HIV, incidence was 14.6%, and in the male general population incidence was 12.8%.

Losina and colleagues wrote that women with HIV had a projected cumulative CVD incidence of 13.8%, vs. 9.7% in women at high risk for HIV and 9.4% in the general population.

Men living with HIV had a lifetime CVD risk of 64.8%, compared with 54.8% in the general population, the researchers reported. However, the risk was similar across groups of women.

Losina and colleagues acknowledged that the study was limited by the fact that smoking was explicitly modeled as a CVD risk factor across groups, whereas other risk factors were modeled implicitly. The study also made no investigation into racial or ethnic differences, duration of smoking, infection duration or means of HIV acquisition.

“While CVD is increasingly recognized as a common cause of death in treated [persons living with HIV], additional attention and guidance should be paid to CVD screening and risk factor counseling for [persons living with HIV],” the researchers wrote. “Given that the projected CVD risk among [persons living with HIV] was similar to those with diabetes, we believe that HIV should be considered a major risk factor for CVD and that [persons living with HIV could benefit from preventive strategies similar to persons with diabetes mellitus. It is critical to test the effectiveness of CVD primary prevention therapies for [persons living with HIV].” – by Andy Polhamus

Disclosure: Losina reports no relevant financial disclosures. Please see the full study for a complete list of all other researchers’ relevant financial disclosures.