Guidelines Issued for Addressing Heart Disease Risk in HIV

People living with HIV (PLWH) have an increased risk for cardiovascular disease (CVD), a risk that needs appropriate management and treatment, according to a scientific statement issued by the American Heart Association and published online June 3 in Circulation.

Matthew J. Feinstein, M.D., from Northwestern University in Chicago, and colleagues address the characteristics, prevention, and management of CVD among PLWH.

The authors note that individuals with HIV have significantly higher rates of myocardial infarction, heart failure, stroke, and other CVD manifestations compared with uninfected controls, even in the setting of HIV viral suppression. Traditional atherosclerotic CVD (ASCVD) risk factors are associated with elevated ASCVD risk among PLWH; in addition, HIV infection is associated with elevated ASCVD risk, especially for those with low current or nadir CD4 count or a history of sustained, untreated HIV. The first step for primary and secondary prevention of CVD is adherence to a healthy lifestyle, including smoking cessation, which is prevalent among PLWH. Statin use is complicated by drug-drug interactions in HIV, but most statins can be safely prescribed; other agents to potentially reduce CVD risk include antithrombotic agents, which are underused in HIV.

"There is a dearth of large-scale clinical trial data on how to prevent and treat cardiovascular diseases in people living with HIV," Feinstein said in a statement. "This is an area of research that is needed for informed decision-making and effective CVD prevention and treatment in the aging population of people living with HIV."

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