People living with HIV face premature heart disease and barriers to care

Effective antiretroviral therapy has turned the human immunodeficiency virus (HIV) from a life-threatening progressive disease into a chronic, manageable disease that is badociated with higher rates of heart attack, stroke, heart attack, Sudden heart death and other illnesses compared to unaffected people. HIV, according to a new scientific statement from the American Heart Association published in the journal of the Association circulation.

People living with HIV are at increased risk for heart and blood vessel disease because of interactions between traditional risk factors such as diet, lifestyle and smoking, and risk factors specific to HIV. HIV, such as the chronically activated immune system and the characteristic inflammation of chronic diseases. HIV.

Smoking, a major risk factor for cardiovascular disease, is common among people living with HIV. In a nationally representative sample of Americans, 42% of people living with HIV were current smokers. Excessive consumption of alcohol, substance abuse, mood and anxiety disorders, low level of physical activity and poor cardiorespiratory fitness are also common among people living with alcohol. HIV and can contribute to a high risk of heart disease and blood vessels, the statement said.

"Our knowledge of HIV-related heart disease and blood vessels is considerable, in part because the transition from HIV from a life-threatening disease to a chronic disease is relatively new and long-term risk data heart disease are therefore limited, "said the minister. Matthew J. Feinstein, MD, MSc, chairman of the statement writing group and badistant professor of medicine and preventive medicine at the Feinberg School of Medicine at Northwestern University in Chicago, Illinois.

In addition, people living with HIV are often stigmatized and face significant barriers to optimal health care, such as their level of education, standard of living, lack of voting rights, and cognitive impairment. , their injecting drug use, their untimely and anticipated stigmatization, their approach. and reduced mobility, frailty, depression and social isolation. There are also disparities in care according to age, race, ethnicity and gender.

The aging of the population living with HIV is another source of concern: 75% of people living with HIV are over 45 years old. "Aging with HIV is very different from the aging issues that the general population faces," said Jules Levin, MS accompanying the patient's perspective. Levin has been living with HIV for 35 years and is the founder and executive director of the National AIDS Treatment Advocacy Project.

"On average, people living with HIV over the age of 60 have between 3 and 7 health problems, including heart attacks, strokes, heart failure, kidney disease, weakness, and heart disease. and many people take 12 to 15 drugs a day, people living with HIV are often single and disabled, attached to their homes because of depression and socially isolated, in addition to lack of mobility and disability. "Doing their normal daily tasks." We urgently need better awareness and focused research and care efforts for this vulnerable population, "said Levin.

It is also difficult to provide scientific recommendations on how to reduce the risk of cardiovascular disease in people living with HIV. "There are few large-scale clinical trial data on how to prevent and treat cardiovascular disease in people living with HIV – it is a necessary area of ​​research for informed decision-making. and effective prevention and treatment of CVD in the elderly, people living with HIV, "said chairman of Feinstein's writing group.

To badess the cardiovascular risk of a person living with HIV, the statement recommends a nuanced approach. This approach includes quantifying the traditional burden of risk factors for heart disease using tools such as atherosclerotic disease risk calculator, which badesses a person's risk over a 10-year period. have a heart attack, stroke, or other cardiovascular disease. point. However, the authors warn that people living with HIV may be at higher risk than the calculator. Other factors to be considered in badessing the risk of heart disease include family history of heart disease and HIV-specific factors, such as initiating antiretroviral therapy by a patient shortly after diagnosis.

To keep people living with HIV healthy, Feinstein stresses the importance of a healthy lifestyle that includes quitting smoking, adequate physical activity, eliminating or reducing alcohol consumption. and a healthy diet. In addition, drugs such as statins, which lower cholesterol, and other drugs making the blood less likely to form clots can be helpful even though more clinical trial data are needed.