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Focus on the heart: alcohol consumption, HIV infection, and cardiovascular disease
Matthew S Freiberg1, Kevin L Kraemer
1Center for Research on Health Care, University of Pittsburgh, all in Pittsburgh, Pennsylvania.
Insights
Effective HIV treatment increases life expectancy, raising cardiovascular disease (CVD) risk. Excessive alcohol consumption further elevates this risk in HIV-infected individuals through inflammation and gut barrier dysfunction.
Area of Science:
- Cardiology
- Infectious Diseases
- Toxicology
Background:
- Effective antiretroviral therapy (ART) has improved life expectancy for people with HIV (PLWH).
- PLWH are increasingly susceptible to chronic conditions, including cardiovascular disease (CVD).
- Alcohol consumption is prevalent among PLWH and may impact CVD risk.
Purpose of the Study:
- To examine the influence of alcohol consumption on cardiovascular disease (CVD) risk in HIV-infected individuals.
- To understand the mechanisms by which alcohol affects CVD risk in the context of HIV infection and its treatment.
Main Methods:
- Review of existing literature on alcohol consumption, HIV, and cardiovascular disease.
- Analysis of alcohol's effects on CVD risk factors in both HIV-negative and HIV-positive populations.
- Investigation of shared and distinct pathways linking alcohol, HIV, ART, and CVD.
Main Results:
- Moderate alcohol intake may reduce CVD risk in the general population, while heavy drinking increases it.
- HIV infection and ART can independently increase CVD risk by altering lipid levels, promoting inflammation, and affecting blood clotting.
- Excessive alcohol use exacerbates CVD risk in PLWH through these mechanisms and by promoting microbial translocation, leading to inflammation.
Conclusions:
- Excessive alcohol consumption poses a significant additional CVD risk for HIV-infected individuals.
- Understanding these interactions is crucial for managing cardiovascular health in aging PLWH.
- Public health strategies should address alcohol use as a modifiable risk factor for CVD in this population.
Abstract:
With the advent of effective antiretroviral therapy, people infected with HIV have a longer life expectancy and, consequently, are likely to develop other chronic conditions also found in noninfected people, including cardiovascular disease (CVD). Alcohol consumption, which is common among HIV-infected people, may influence the risk of CVD. In noninfected adults, moderate alcohol consumption can reduce the risk of coronary heart disease (CHD), heart attacks, and the most common type of stroke, whereas heavy drinking increases the risk of these cardiovascular events. These relationships can be partially explained by alcohol's effects on various risk factors for CVD, including cholesterol and other lipid levels, diabetes, or blood pressure. In HIV-infected people, both the infection itself and its treatment using combination antiretroviral therapy may contribute to an increased risk of CVD by altering blood lipid levels, inducing inflammation, and impacting blood-clotting processes, all of which can enhance CVD risk. Coinfection with the hepatitis C virus also may exacerbate CVD risk. Excessive alcohol use can further enhance CVD risk in HIV-infected people through either of the mechanisms described above. In addition, excessive alcohol use (as well as HIV infection) promote microbial translocation, the leaking of bacteria or bacterial products from the intestine into the blood stream, where they can induce inflammatory and immune reactions that damage the cardiovascular system.
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