June 12, 2019 – The statement suggests that when treating people living with HIV who exhibit certain characteristics, clinicians should multiply conventional risk calculator scores by 1.5 to 2.
The DCRI’s Gerald Bloomfield, MD (pictured), contributed to a statement from the American Heart Association recently published in Circulation that provides a thorough review of current knowledge on HIV-associated cardiovascular disease, as well as a gap analysis that details where more data are needed.
This statement was needed because currently no guidelines exist on how to address cardiovascular disease in people living with HIV, Bloomfield said. Because HIV used to be fatal, little is known about how people living with the virus experience cardiovascular disease. However, a number of observational studies have shown that as treatment for HIV has improved, people living with HIV are living longer and experiencing more age-related comorbidities, including cardiovascular disease.
“This population deserves special attention when assessing and treating for cardiovascular disease,” Bloomfield said. “We know that chronic exposure to HIV increases heart disease risk, so in treating people with HIV, we need to be aware that the underlying contributors to the disease may extend beyond traditional factors.”
For example, he explained, HIV affects heart muscle contraction in unique ways, increasing risk of heart failure. More data are needed to further understand the long-term impacts of these increased risks, as well as to address treatment and prevention. In addition to heart failure, the statement also addresses increased risk for heart attack and stroke which may be driven by the body’s chronic inflammatory response to the HIV virus.
Another important component of the paper, which distinguishes it from many statements made by the AHA, is that it examines how suggested guidelines could be applied outside the U.S.
“Because 70 percent people living with HIV live in Africa, our writing group thought it was important to discuss unique characteristics of HIV and cardiovascular disease in sub-Saharan Africa,” Bloomfield said. “If we had not addressed this, I think we would have been remiss.”
The paper also suggests that conventional risk calculators may under-predict risk for patients in this population and, for HIV+ patients with certain characteristics, recommends that clinicians multiply risk scores by 1.5 to 2.
“This is novel because there is no solid clinical trial data that supports this suggestion,” Bloomfield said. “However, because there are a large number of people living with HIV who are aging and clinicians are wondering what to do and how to treat them, we felt it was important to offer guidance now based on the best available evidence.”
Bloomfield added that studies are currently underway that will shed more light on this topic in a few years, such as the REPRIEVE trial, which the DCRI’s Pamela Douglas, MD, is working on.