Guide to side effects and complications
www.i-Base.info
Heart disease
CVD=Cardiovascular disease
When lipodystrophy and metabolic changes associated with combination therapy became more widely recognised, there was an initial concern that these symptoms could increase the risk for heart attack or stroke.
• People at high risk for heart disease may need to take any additional risk more seriously.
This is because increased levels of blood lipids can lead to blocking blood vessels (atherosclerosis) and are a wellestablished risk factor for heart disease.
• Making lifestyle changes that minimise risk factors are now strongly recommended as part of a long term plan for managing HIV positive patients.
This concern was prompted by a series of case reports of heart attacks in HIV positive men who were too young to be considered as traditionally at high risk. However, the risk of heart disease may be increased more by untreated HIV than by HIV meds. Several large studies have reported results that calm some of these initial fears. • Benefits of combination therapy still far outweigh the possible slight increased risk of heart disease for most HIV positive people. • The SMART study found that using HIV treatment with an undetectable viral load was protective of heart disease compared to not being on treatment or having a detectable viral load.
• Risk factors for heart disease in HIV positive people are the same as for people who are HIV negative.
There is a lot of information and research about risk factors for heart disease in HIV negative people. This has often come from very large studies (Framingham, Caerphilly etc) that followed a large group of people for many decades. These studies led to the development of risk calculators that are easy to access online (see page 71 for links). If you put in your age, gender, cholesterol and triglyceride levels and other risk factors such as smoking, you get your 5-year or 10-year risk of heart disease. People with high risk factors for heart disease who need HIV treatment, should use HIV drugs that are least likely to increase the risk of cardiovascular disease any further. Support for lifestyle changes should also be provided.
• The D:A:D study reported a small additional increase in risk of heart disease from each year on some HIV meds including lopinavir/r (Kaletra), abacavir and ddI.
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July 2012