Treating Cardiovascular Problems in Patients with HIV

Andrew Rudin Md (1)

HIV was once regarded as a death sentence. During the 80s and early 90s, it killed millions, mostly very young people. Today, an estimated 1.2 million people in the US are living with HIV. Most of them are survivors of the initial epidemic. They are now over 50 years old.

This tells us some good news. With antiretroviral therapy, or ART, HIV has become a manageable chronic disease. Some people have become flippant about HIV, dismissing it as nothing more than “gay diabetes.” The bad news, however, is that HIV patients face additional healthcare challenges, particularly as they age. They face diseases like diabetes, kidney disease and cardiovascular disease, just like other people.

In fact, HIV patients have increased risk for cardiovascular disease. They are more likely to deal with heart failure, heart attack and stroke. This raises a number of important questions. Should HIV specialists direct the care of patients with both HIV and cardiovascular disease, or cardiologists? Neither specialty has much in common with the other. Recently, the Canadian Journal of Cardiology provided a look at the unique challenges faced by HIV patients who also deal with cardiovascular disease. In a special issue, they take a look at the additional challenges posed by CVD when it presents in people with HIV.

At one point in time, ART was associated with weight gain and high cholesterol. Current antiretroviral medications don’t have those same side effects. The heightened risk persists.

Some doctors hypothesize that HIV itself may lead to inflammation. This, in combination with changes to the immune system, may contribute to the increased risk of cardiovascular disease. HIV patients with CVD present at younger ages, are more likely to die in hospital, and face other increased risks. It’s clear that HIV complicates CVD.

In treating patients with comorbidity, doctors also need to be aware of drug interactions and take additional precautions during surgeries. The good news is that in the developed world, HIV is on the decline. It overwhelmingly affects people aged 50 and over, with a sharp drop-off in younger cohorts. The hope among cardiologists is that this concern will be much less pressing as time goes on.