AHA issues guidelines addressing heart disease risk in HIV

  • Feinstein MJ & al.
  • Circulation
  • 3 Jun 2019

  • International Clinical Digest
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  • Newly released American Heart Association (AHA) guidance reinforces that people living with HIV (PLWH) have significantly greater risk for various types of cardiovascular disease (CVD) vs uninfected population.
  • PLWH whose risk-enhancing factors are related to HIV might benefit from CVD-preventive therapy.

Why this matters

  • Use American College of Cardiology/AHA atherosclerotic cardiovascular disease (ASCVD) Risk Calculator (or other similar tool) to identify virally suppressed HIV-infected patients with elevated ASCVD risk.
  • Consider HIV-associated factors linked to elevated ASCVD: 1) history of prolonged HIV viremia and/or delayed antiretroviral therapy (ART) initiation; 2) low current/nadir CD4 count (3); 3) ART treatment failure/nonadherence; 4) metabolic syndrome, lipodystrophy/lipoatrophy, fatty liver disease; 5) hepatitis C coinfection.
  • Consider a cardiologist referral in high-risk patients for lifestyle optimization, lipid-lowering therapy.
  • If statins are indicated, pravastatin and pitavastatin are least likely to interact with ART.

Key points

  • Relative risk for various CVD manifestations in PLWH is 1.5- to 2.0-fold greater than in uninfected persons.
  • Underlying mechanisms likely due to interplay between traditional and HIV-related risk factors, ART-related dyslipidemia, behavioral/lifestyle factors (smoking, alcohol, diet, exercise), access to care.
  • Low-moderate risk strategy: annual risk reassessment coupled with lifestyle optimization (especially smoking cessation) recommended.
  • Consult guidance for specific ASCVD manifestations in HIV.

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