HIV blocks and hardens arteries
posted: 07/01/2010
Even young men with HIV are more likely to have hardening of the arteries than similar men who don’t have HIV. The researchers also found that arterial disease was so severe in 7% of men with HIV that it was blocking blood flow. The longer people have lived with HIV the more likely coronary arteries have hardened and narrowed.
Anti-HIV treatment significantly extends the life expectancy of people with HIV. HIV-related illnesses are now uncommon among people taking treatment but there’s a lot of evidence for a much greater risk of various diseases of ageing, including cardiovascular disease. Hardening and narrowing of the arteries are types of cardiovascular disease.
Spot it early and act
Getting cardiovascular disease spotted early means people can get the right treatment and lifestyle advice to help make a difference to health and cut the risk of heart attacks and strokes later.
A USA study published in AIDS used coronary computed tomography (CT) angiography (a scan of the coronary arteries) to look for and carefully measure any hardening of the coronary arteries before any symptoms showed up. It shows how much plaque (fatty and other deposits) line the arteries and how narrow the arteries have become.
It is HIV that raises the risks
The investigators compared 78 HIV-positive men and 32 HIV-negative men to see if having HIV raised the risk of hardening of the arteries. It did. There was a significant difference. 59% of those with HIV had arteriosclerosis compared to 34% of HIV-negative men and this remained true even after taking out of the equation the traditional risk factors for cardiovascular disease.
They found that the men with HIV had significantly more and thicker arterial plaques (a build-up of deposits lining and narrowing the arteries).
Seriously narrowed arteries found in 7% of HIV+ men
They had more arterial calcium scores, and 7% had seriously narrowed arteries - coronary stenosis – where the arteries were 70% narrower.
None of the HIV-positive men had shown any symptoms of hardened arteries or had any history of heart or kidney disease before they were picked for this scanning trial. On average, they had HIV infection for 14 years; 95% were on anti-HIV treatments, with good CD4 counts (median 523 cells/mm3), and 81% had an undetectable viral load. There were no significant differences between the positive and negative men in the traditional risk factors for cardiovascular disease: the men’s ages, family history of heart disease, blood pressure, cholesterol and Framingham risk scores (the ten year risk of heart disease) were all comparable.
Narrowed arteries linked to how long you’ve had HIV
After taking account of the HIV positive men’s ages and 10 year heart attack risk, the duration of HIV infection remained significantly associated with both the number of plaques and plaque volume.
This is not affected either by treatment with a protease inhibitors, levels of lipids, or CD4 cell count, viral load, or how long you’ve been on HIV treatment.
“The prevalence of coronary artery disease in HIV-infected patients was significantly greater than that seen in…HIV-sero-negative men with similar demographics, Framingham risk scores, and traditional risk factors”, note the investigators.
Even young men can be severely affected
They add, “surprisingly and of important clinical relevance, even among asymptomatic young HIV-infected men, 6.5% had evidence of severe coronary arterial disease…in contrast, [only] one of the controls had severe obstructive coronary arterial disease.”
This study looks likely to raise more worries and questions about why people with HIV have more risk of heart disease. The investigators comment, “our data…support the hypothesis that there is a relationship between HIV infection and coronary artery atherosclerosis independent of traditional risk factors as [these] were generally similar between the two groups.”
Duration of HIV infection had a “significant and robust” relationship with hardening of the coronary artery.
Act early to reduce the risks from other causes
“Our data highlight the need to address cardiac risk reduction early on in the course of HIV disease”, conclude the researchers.
This means not smoking, keeping to a healthy weight, 5 fruit and vegetables a day, regular exercise to get the heart pumping, cut back on alcohol, and the like.
Image credit: US National Heart, Lung, and Blood Institute
Source
Reference
Lo J et al. Increased prevalence of subclinical coronary atherosclerosis detected by coronary computed tomography angiography in HIV-infected men. AIDS (online edition), 2009.
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