According to Steven Grinspoon, Chair of a meeting held between the American Heart Association and the American Academy of HIV Medicine, lack of awareness of the risk of cardiovascular disease isequally prevalent among HIV physicians and cardiologists.
The excess risk of cardiovascular disease among those living with HIV is a product of both the disease itself and the drugs used to treat it. Experts who participated in the meeting emphasise that while antiretroviral therapy is largely responsible for improving and extending the lives of people with HIV, the drugs also appear to increase the risk of cholesterol abnormalities, pulmonary hypertension, and pericardial disease in a group that already has a higher prevalence of other common risk factors for CVD. Indeed, one of the points made by Grinspoon et al in the executive summary is that researchers do not know the relative contribution to CVD of the drug therapy versus the underlying disease.
Several recent studies have suggested that traditional risk factors, such as dyslipidemia, hypertension, and diabetes, likely only account for 25% of the excess risk in HIV-positive individuals. "But there are also some nontraditional risk factors, like inflammation, that may be responsible for an even greater proportion of CV risk in these patients," says Grinspoon. "It became apparent to people at the conference that this is probably a very complicated interplay between risks that were brought about via the adverse effects of the anti-HIV drugs and also risks of the virus itself."
Another point emphasised by the meeting is that while some research has emphasised the cardiovascular risks posed by HIV medication, other research has shown the importance of adherence to therapy.
All participants at the meeting emphasised the importance of lifestyle changes, such as stopping smoking, a healthy diet and regular exercise for those living with HIV, as a way to combat their increased risk of cardiovascular disease.
