Scientists: HIV should be considered a major risk factor for cardiovascular disease

People living with HIV are twice as likely to suffer from cardiovascular disease (CVD), the results of a meta-analysis published in Circulation magazine show. According to researchers, over the past 20 years, the number of CVDs associated with HIV has tripled. Today this is about 1% of all cases of heart disease in the world.

A relatively high proportion of cardiovascular events in the HIV + group (60 per 10,000 person-years) was comparable to high-risk CVD groups, the researchers write. According to specialists, HIV should be considered as one of the key risk factors for CVD along with diabetes, hypertension, high cholesterol and smoking.

Thanks to modern antiretroviral therapy, people living with HIV have a life expectancy that is not different from ordinary people, and the causes of their death are increasingly becoming diseases not associated with HIV (especially CVD).

Therefore, an international group of scientists decided to determine how high the risk of heart disease in HIV-positive people. According to the AIDS map, recent studies have identified probable biological mechanisms for the direct link between HIV and cardiovascular diseases, including vascular inflammation, dyslipidemia, and insulin resistance.

The specialists conducted a systematic review and meta-analysis of all studies published before 2015, which examined the interrelationship and interdependence of HIV and CVD.

The authors attempted to answer three questions:

• Do people with HIV have an increased risk of CVD?
• What is the risk of developing CVD, directly related to HIV?
• What is the burden of HIV-related cardiovascular diseases?

A total of 80 studies conducted between 1990 and 2015 met the stated criteria.

According to the analysis, the incidence of CVD among HIV-positive patients was 61.8 per 10,000 person-years. The mortality from heart disease in HIV + was 14.1 per 10,000 person-years (that is, in a group of 10,000 people with HIV, 14 died per year from CVD).

In comparison with HIV-negative people, the risk of developing cardiovascular disease in HIV + was twice as high (RR = 2.16, 95% CI, 1.68-2.77).

The share of cases of cardiovascular diseases associated with HIV increased from 0.36% to 0.92% between 1990 and 2015.

Specialists also noted some regional differences in the number of CVD cases associated with HIV. In 2015, more than two thirds of such cases occurred in East and South Africa, the Asia-Pacific region and West and Central Africa.

According to national estimates, HIV + accounts for at least 15% of CVD cases in Swaziland, Botswana, Lesotho and South Africa. HIV-associated CVD in equatorial and southern Africa increased from 210,000 in 1990 to 740,000 in 2015.

"The cumulative burden of HIV and cardiovascular disease in countries [with high HIV infection rates," Ed.] Is causing growing concern and has important implications for regional strategies, guidelines and resource allocation for health, "the authors comment on the results of the analysis .

In their opinion, the time has come for HIV to be included among the main risk factors for CVD. This will allow us to better understand the origins of the problem and raise the awareness of doctors about the real state of affairs. The latter, in turn, will improve the prevention, detection and treatment of CVD in people living with HIV.