People living with HIV face challenging CVD health risks and barriers to accessing care

American Heart Association

Research shows that people living with HIV have a significantly high risk for cardiovascular disease – as much as 2 times higher for heart attack and heart failure and 14% higher for sudden cardiac death than people without HIV. So, while many people living with HIV/AIDS are experiencing full, quality lives as AIDS has transitioned from a progressive, fatal disease to what is now a mostly manageable, chronic condition more than three decades after the first World AIDS Day was recognized on Dec. 1, 1988, challenges persist. Not only from increased other health issues, but also navigating a health care system that can still be discriminatory, as outlined in several scientific statements published by the American Heart Association, the world’s leading voluntary organization dedicated to building longer, healthier lives for all.

Characteristics, Prevention, and Management of Cardiovascular Disease in People Living With HIV: A Scientific Statement From the American Heart Association – In this scientific statement released in June 2019, the Association reported that living with HIV is associated with higher rates of heart attacks, strokes, heart failure, sudden cardiac deaths and other diseases, compared with people without HIV. The statement writing group’s chair, Matthew J. Feinstein, M.D., M.Sc., said this may be because of interactions between traditional risk factors, such as unhealthy diet, lifestyle and tobacco use, and HIV-specific risk factors, such as a compromised immune system and inflammation characteristic of chronic HIV.

“Lifestyle and clinical factors play major roles in the increased risk for heart disease among people with HIV,” said Feinstein, an assistant professor of Medicine-Cardiology at Northwestern University in Chicago who specializes in cardiovascular risk in infectious and inflammatory conditions. “In people with HIV, cigarette smoking is quite common. This dovetails with a number of factors – ranging from chronic inflammatory and metabolic effects of HIV and its therapies to psychosocial stressors related to stigma and substance use disorders – to lead to increased risk for cardiovascular diseases among people with HIV.”

The American Heart Association recommends people living with HIV talk to their doctor and assess their cardiovascular disease risk using a tool such as the American Heart Association/American College of Cardiology Atherosclerotic Disease Risk Calculator, which estimates a person’s ten-year risk of having a heart attack, stroke or other cardiovascular condition. The Association cautions that the risk calculator is a starting point as people living with HIV may have a higher risk than indicated by the calculator. Other factors to consider in risk assessment include family history of heart disease and HIV-specific factors, such as whether or not a patient started antiretroviral therapy soon after diagnosis.

To help improve the health of people living with HIV, the Association emphasizes the importance of a healthy lifestyle that includes not smoking, adequate physical activity, eliminating or reducing the amount of alcohol consumed and a healthy diet in keeping with the guidance in Life’s Simple 7 – the seven risk factors that people can improve through lifestyle changes to help achieve ideal cardiovascular health.

Assessing and Addressing Cardiovascular Health in LGBTQ Adults: A Scientific Statement of the American Heart Association – This scientific statement published in Oct. 2020, highlights the additional challenges LGBTQ people, a population especially vulnerable to living with HIV/AIDS, face in the form of discrimination in the health care setting. The writing group noted trust toward health care professionals is still lacking among many members of the LGBTQ community – more than half (56%) of LGBTQ adults and 70% of those who are transgender or gender non-conforming report experiencing some form of discrimination, including the use of harsh or abusive language, from a health care professional. “LGBTQ individuals often skip primary care and preventative visits because there is a great fear of being treated differently,” said the chair of the writing group for this statement, Billy A. Caceres, Ph.D., R.N., FAHA, an assistant professor at the Columbia University School of Nursing in New York City. “Being treated differently often means receiving inadequate or inferior care because of sexual orientation or gender identity.”

Although much progress has been made over the past decade in understanding HIV-associated cardiovascular disease, considerable gaps exist, and more research is needed to address the growing physical and sociological challenges.

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