HIV infection, aging and cardiovascular disease: epidemiology and prevention

Abstract

Abstract. In the developed world, HIV infection is now well managed with very effective and less toxic antiretroviral treatment. HIV-positive patients therefore are living longer, but are now faced by challenges associated with aging. Several non-AIDS associated morbidities are increased in this population, including cardiovascular disease (CVD). It is suggested that CVD occurs earlier among HIV-positive patients compared with HIV-negative patients, and at a higher rate. Several factors have been proposed to contribute to this. First, the traditional CVD risk factors are highly prevalent in this population. High rates of smoking, dyslipidaemia and a family history of CVD have been reported. This population is also aging, with estimates of more than 25% of HIV-positive patients in the developed world being over the age of 50. Antiretroviral treatment, both through its effect on lipids and through other, sometimes less well understood, mechanisms, has been linked to increased CVD risk. HIV infection, especially untreated, is a further contributing factor to increased CVD risk in HIV-positive patients. As the HIV-positive population continues to age, the risk of CVD will continue to increase. Guidelines for the management and prevention of CVD risk have been developed, and are largely modelled on those used in the general population. However, the data currently suggest that these interventions, such as the use of lipid-lowering medications and smoking cessation programs, remain quite low. A better understanding the mechanisms of CVD risk in this aging population and further efforts in improving uptake of prevention strategies will remain an important research area.

HIV‐infected patients' beliefs about their chronic co‐treatments in comparison with their combined antiretroviral therapy

“…The major comorbidity in our study was cardiovascular disease. It has been suggested that there is an earlier onset of cardiovascular disease among HIV‐positive compared with HIV‐negative adults . This is mainly due to the HIV population aging, but this earlier onset is also associated to the HIV infection and antiretroviral treatment .…”

Mind the gap: difference between Framingham heart age and real age increases with age in HIV-positive individuals–a clinical cohort study

“…The increased burden of CVD among HIV-positive individuals is likely a consequence of increased traditional risk factors, including dyslipidemia and insulin resistance and non-traditional risk factors such as immune activation and inflammation that may contribute to the accelerated ageing process characterised by higher than expected rates of non-infectious comorbidities 17. Higher prevalence of smoking also contributes to the CVD epidemic in the HIV-positive population18 19 as may the use of recreational drugs.…”

Association between Phosphatase Related Gene Variants and Coronary Artery Disease: Case-Control Study and Meta-Analysis

“…Age is a predictor of CAD [30]. The incidence of cardiovascular disease in older persons above 65 years is about 80% higher than that in the younger persons [31].…”