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Characteristics, Prevention, and Management of Cardiovascular Disease in People Living With HIV: A Scientific
Insights
People with HIV face higher risks of cardiovascular diseases (CVDs), including heart attack and stroke, even with managed virus. This review addresses CVD prevention and treatment in HIV patients.
Area of Science:
- Cardiology
- Infectious Diseases
- Public Health
Background:
- HIV has shifted from a fatal illness to a chronic condition with increased risk of comorbidities.
- People with HIV experience significantly higher rates of cardiovascular diseases (CVDs) like myocardial infarction, heart failure, and stroke compared to uninfected individuals.
- These elevated CVD risks persist even with viral suppression and are linked to chronic inflammation and immune dysregulation.
Purpose of the Study:
- To comprehensively review existing evidence on HIV-associated cardiovascular diseases, focusing on atherosclerotic CVD and heart failure.
- To provide pragmatic recommendations for CVD prevention and treatment in people living with HIV.
- To address the need for improved understanding and management strategies due to limited long-term outcome data.
Main Methods:
- Review of large observational studies.
- Analysis of randomized controlled trials of HIV therapies (noting limitations for CVD endpoints).
- Examination of small interventional studies using surrogate CVD endpoints.
Main Results:
- Elevated risks for myocardial infarction, heart failure, stroke, pulmonary hypertension, and sudden cardiac death in people with HIV.
- Persistence of these risks after accounting for demographic and clinical factors.
- Attribution of increased risk partly to chronic inflammation and immune dysregulation associated with HIV.
Conclusions:
- HIV infection is associated with a substantially increased burden of cardiovascular disease.
- Effective antiretroviral therapy manages HIV but does not fully eliminate CVD risk.
- Further research and tailored clinical strategies are crucial for CVD prevention and management in the growing population of people living with HIV.
Abstract:
As early and effective antiretroviral therapy has become more widespread, HIV has transitioned from a progressive, fatal disease to a chronic, manageable disease marked by elevated risk of chronic comorbid diseases, including cardiovascular diseases (CVDs). Rates of myocardial infarction, heart failure, stroke, and other CVD manifestations, including pulmonary hypertension and sudden cardiac death, are significantly higher for people living with HIV than for uninfected control subjects, even in the setting of HIV viral suppression with effective antiretroviral therapy. These elevated risks generally persist after demographic and clinical risk factors are accounted for and may be partly attributed to chronic inflammation and immune dysregulation. Data on long-term CVD outcomes in HIV are limited by the relatively recent epidemiological transition of HIV to a chronic disease. Therefore, our understanding of CVD pathogenesis, prevention, and treatment in HIV relies on large observational studies, randomized controlled trials of HIV therapies that are underpowered to detect CVD end points, and small interventional studies examining surrogate CVD end points. The purpose of this document is to provide a thorough review of the existing evidence on HIV-associated CVD, in particular atherosclerotic CVD (including myocardial infarction and stroke) and heart failure, as well as pragmatic recommendations on how to approach CVD prevention and treatment in HIV in the absence of large-scale randomized controlled trial data. This statement is intended for clinicians caring for people with HIV, individuals living with HIV, and clinical and translational researchers interested in HIV-associated CVD.
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