- 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.
- 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.