HIV-positive people need to be targeted for heart disease screening and treatment, according to one of the largest studies of HIV and cardiac health ever conducted; published in the October 15th edition of Clinical Infectious Diseases.

Long-term antiretroviral therapy, particularly including a protease inhibitor, is known to increase the risk of coronary heart disease (CHD), by around 40 percent over six years of follow-up, according to the results of the DAD study, chiefly due to the lipid elevations associated with protease inhibitor treatment. In general, the incidence of CHD in the HIV-positive population has been low due to the relatively young age of the positive community because patients have tended to be young. However, ageing of the HIV population in the developed world – a consequence of effective HIV treatment – now means heart disease and stroke are becoming leading causes of death in people living with HIV as they are in the general population. US researchers have calculated the risk of developing CHD in HIV positive men and women using two large cohorts of HIV-infected and noninfected people, the Women’s Interagency HIV Study and the Multicenter AIDS Cohort Study.

Researchers calculated a ten-year CHD risk, that is the chances of having a myocardial infarction (heart attack) or coronary death in the next ten years. Among HIV-positive men, they found 2 percent of them had a ‘moderate’ predicted risk of CHD that is a 15 to 25 percent risk of a heart attack or coronary death in the next ten years. But 17 percent of men had ‘high’ risk that is a ten-year CHD risk of 25 percent or over. In HIV-positive women 2 percent had moderate predicted CHD risk and 12 percent had high-predicted CHD risk.

Overall, HIV-positive people who were treatment naive were significantly less likely to have moderate or high predicted CHD risk than those who were taking antiretroviral therapy containing a protease inhibitor Other factors associated with increased likelihood of having a moderate to high predicted CHD risk were obesity, and low income But they also found a high number of current smokers among the HIV-positive cohorts - 35 percent of men and 43 percent of women - which is also known to substantially increase the risk of developing CHD.

They conclude that the data show people on a PI-containing antiretroviral therapy are more likely to develop CHD than positive people who are either treatment-naive or on a regime that does not contain a PI. But low household income was also strongly related to predicted coronary risk. Finally, intervening on risk factors such as being overweight and smoking presents an opportunity to reduce the risk of heart diseases as well as improving HIV disease progression.

An editorial accompanying the stresses the findings have important public health implications as they suggest screening HIV infected people for heart disease and attempting to tackle the risk factors might be valuable