One study found 50 percent higher risk of heart attack
Human immunodeficiency virus infection is no longer the death sentence it was 30 years ago, but HIV-infected adults may face a new health hurdle—heart disease.
Studies show HIV-infected adults have higher heart risks than people without the virus. A 2013 study found 50 percent higher risk of heart attack in those studied, while a 2012 study suggested more inflammation in heart arteries.
A large, international study, known as REPRIEVE, is currently looking at statin drug treatment can reduce the risk for cardiovascular disease in HIV-infected adults ages 40-75 who are taking antiretroviral drugs, without a history of heart disease or stroke. The participants also had a low to moderate risk of cardiovascular disease for starting a statin.
Average participation in the trial will last four to five years and 6,500 people will be enrolled at 100 sites, including Canada, Puerto Rico, the United States and Thailand. Participants will receive the statin drug pitavastatin or a placebo.
“The study is really important because we don’t recognize how much inflammation related to HIV may be accelerating [patients’] risk of having heart disease,” said Mamta Jain, M.D., associate professor of internal medicine at UT Southwestern Medical Center in Dallas, a study site. “People may be at increased risk just because they have HIV.”
Antiretroviral drug treatment has allowed people with HIV to live into old age by controlling the life cycle and spread of the virus. But even with viral levels under control, HIV may contribute to heart disease by increasing inflammation in the blood vessels, say experts.
“The beauty of statins is they have anti-inflammatory properties,” which could counteract inflammation from HIV, said Steven Grinspoon, M.D., a neuroendocrinologist at Massachusetts General Hospital and professor of medicine at Harvard Medical School in Boston, who is one of the leaders of the REPRIEVE trial.
More than 1.2 million people age 13 and older were living with HIV infection in the U.S. in 2011, the most recent data available. About 44,000 cases were diagnosed annually as of 2014, according to the Centers for Disease Control and Prevention.
If untreated, HIV destroys the body’s immune system in stages, by killing off a type of white blood cells that help fight off infections. In its final stage, the body is virtually defenseless against deadly cancers and other infections.
From an infectious disease standpoint, “HIV is a huge success,” Dr. Grinspoon said. “It’s largely controlled.” But people with HIV need to learn more about heart risks, he said.
“I don’t think heart disease is on the radar of HIV patients,” said Dr. Jain, who treats between 300 and 400 patients who have HIV.
The treatments have evolved as medications today keep viral loads in check. Dr. Jain, who has treated HIV patients since 1999, said she is now more focused on preventing heart disease, obesity, diabetes and cancer.
“There is a lot of cardiovascular disease in our aging HIV population and we’re not necessarily recognizing it because they don’t have traditional risk factors,” she said. “Ten years ago I didn’t order a lot of stress tests, but now I am.”
Frank Carroll, age 62, said he didn’t realize his HIV could put him at higher risk of heart disease until he enrolled in the trial earlier this year.
His viral levels have been virtually undetectable for a decade thanks to medication, and he has no heart disease risk factors, although he does battle chronic obstructive pulmonary disease and asthma, which he attributes to heavy smoking in the past.
He lost his mother and recently, his sister, from the effects of smoking.
He’s eager to learn more about heart disease and HIV and hopes to help others with HIV by participating in the trial.
Dr. Grinspoon encourages others with HIV to consider cardiovascular disease a new, major problem to face as well.
“It may be off your radar, but it shouldn’t be.” he said. “Get engaged, become part of the trial, become aware of this risk.”