Emerging concerns: Cardiovascular disease in HIV patients

As the World Aids Day was observed last month, cardiovascular diseases — particularly stroke and coronary heart disease — were highlighted as emerging areas of concern for HIV patients.

According to the UNAIDS 2016 report, 1.1 million people worldwide died of Aids-related illnesses in 2015. By the end of that year, an estimated 36.7 million people around the world were living with HIV.

Since 1996, when antiretroviral therapy (ART) became available, people with HIV have been living longer and healthier lives.

However, as individuals with HIV age, they are more likely to be diagnosed with chronic illnesses and research has named cardiovascular disease as a common occurrence in people over 40 living with HIV.

A number of factors combine to make them more vulnerable to cardiovascular diseases. The virus causes chronic inflammation, which leads to plaque build-up and eventual blockage in the arteries that can cause cardiovascular disease.

Additionally, some ART medications used to treat HIV can raise the risk of heart disease by causing insulin resistance which may lead to diabetes. Researchers have revealed that some kinds of HIV drugs such as protease inhibitors are associated with development of high levels of fat in the blood. Both of these may lead to blockage of blood vessel in various parts of the body. If untreated, this heightens the risk of heart, gall bladder, and pancreatitis diseases.

Also HIV patients who smoke are at higher risk of cardiovascular disease.

HIV itself can further increase the risk of cardiovascular disease. Untreated HIV with its high viral loads has been linked to heart diseases and experts now recommend starting treatment earlier to avoid such cardiovascular damage.

Not only does HIV related inflammation damage the immune and other organ systems, it also accelerates the ageing of blood vessels. The use of ART greatly decreases HIV-related inflammation. Indeed, studies have found that people who stop taking ART have a greatly increased risk for heart attacks and stroke. Nevertheless, low, or un-detectable viral load, low-level inflammation triggered by HIV infection may continue to slowly affect organs and blood vessels, but at a much lower level than before.

But there are steps to prevent and manage this fear.

To begin with, lifestyle changes such as diet, exercise and quitting smoking can greatly reduce the risk of cardiovascular disease. When lifestyle changes are not enough, a number of effective medications and other medical approaches are available. It is also important to take cardiovascular risk factors into account when making crucial HIV treatment decisions, such as when to start, or switch treatment and which medications to use.

But the benefits of ART have been shown to greatly outweigh the dangers and researchers warn against stopping HIV drugs to protect the heart.

Regular monitoring of the levels of cholesterol and triglycerides in the blood and other cardiovascular risk factors in the HIV treatment factors and adoption of prevention, early detection and control can help to control the problem.

Researchers are currently pursuing ways to address the problem of cardiovascular disease among people living with HIV.

Prof Yonga is a consultant cardiologist at Aga Khan University Hospital.