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HIV used to be a death sentence, but advancements in medical treatments are helping patients with HIV/AIDS live longer, healthier lives. Although this is a substantial accomplishment in itself, research is now showing that the infection can pose other health problems for those affected by the virus. Recent data demonstrate that the incidence of cardiovascular disease (CVD) has increased dramatically in patients living with HIV/AIDS. The increased risk has been linked to use of earlier regimens of highly active antiretroviral therapy (HAART). HAART has been very effective for controlling HIV, but has also been associated with elevated CVD risk. Fortunately, recent advancements have enabled clinicians to adjust these therapies, and the risks are considerably lower than previous estimates.

Initially, the use of HAART was so instrumental at keeping HIV at bay that the associated risks for CVD were not a primary concern for physicians because these patients weren’t expected to live long. However, modern medicine has changed, and HIV patients are living longer than ever before. Many patients with HIV will survive well into old age, and clinicians need to consider their risk for CVD as the disease can decrease their lifespan and is associated with significant comorbidities. The good news is that newer versions of HAART have been developed to control viral load levels and simultaneously not increase patients’ risk for CVD.

Reducing CVD Risk in HIV

The means to reduce the risk of CVD in patients with HIV are similar to those for reducing CVD risk in patients without the virus. Patients living with HIV are not prohibited from using modern medicine to treat their CVD risks that result from HIV and/or its treatment. Experts recommend that patients with HIV undergo a more aggressive approach for lowering CVD risks than those without HIV, especially by using strategies aimed at modifying existing risk. This includes using drugs to treat high blood pressure, control blood glucose, and regulate lipid levels. Clinicians should understand and recognize that special attention must be paid to lowering cholesterol and triglyceride levels in patients with HIV because these lipid disorders increase CVD risk.

Address Concerns With Patients

Traditional CVD risk factors should be addressed with lifestyle changes that reduce elevated cholesterol and blood pressure levels. Furthermore, treating insulin resistance and encouraging patients with HIV to become physically active are important steps to reducing CVD risk. Many patients with HIV also smoke, so it’s important to promote smoking cessation and initiate treatment plans when possible. Another contributing factor is that patients with HIV may also be users of other illicit drugs, some of which can increase CVD risk. Addressing tobacco or illegal drug use is essential for this patient group.

In addition to these interventions, it’s paramount that physicians incorporate HIV medications with those designed to treat CVD in a way that is safe and effective for patients. Individuals with HIV should be monitored regularly for CVD risk factors; they should also be provided medications when necessary to further reduce risk. This is a fairly new development in the HIV community, but it’s the onus of physicians to use all available resources so that outcomes can be optimized. If there are concerns about strategies to best treat patients, it may be necessary for clinicians to refer individuals to other specialists.

Robert. H. Eckel, MD has indicated to Physician’s Weekly that he has worked as a consultant and paid speaker for Sanofi-Aventis and Merck, and has received grants/research aid from Sanofi-Aventis.