Federal HIV Guidelines Expand to Include Cardiovascular Health
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- People living with HIV now have updated guidance on managing cardiovascular health, a growing concern as effective treatment allows for longer lifespans.
- What: New HHS guidelines address cardiovascular and metabolic health in people with HIV.
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New HIV Guidelines Address Cardiovascular Health: What People Living with HIV Need to Know
Table of Contents
Updated October 26, 2023
People living with HIV now have updated guidance on managing cardiovascular health, a growing concern as effective treatment allows for longer lifespans. On September 25, the Department of Health and Human Services (HHS) released the latest update to its Guidelines for the Use of Antiretroviral Agents in Adults and adolescents With HIV. This update includes a dedicated chapter focusing on the unique cardiovascular and metabolic challenges faced by individuals with HIV. This article breaks down the key changes, what they mean for you, and what steps you can take to protect your heart health.
Why Cardiovascular Health is a growing Concern for People with HIV
For many years, the focus of HIV care was solely on viral suppression. Thanks to advancements in antiretroviral therapy (ART), people with HIV are now living longer, healthier lives. However, this longevity comes with a new set of challenges: the increased risk of age-related comorbidities, including heart disease, diabetes, kidney disease, liver disease, certain cancers, and cognitive impairment.
These comorbidities are strongly linked to persistent immune activation and chronic inflammation,even in individuals whose viral load is undetectable thru ART. This ongoing inflammation appears to accelerate the development of cardiovascular disease.
Increased Cardiovascular Risk in People with HIV
people living with HIV have approximately a twofold higher risk of developing atherosclerotic cardiovascular disease (ASCVD) compared to their HIV-negative peers. This risk is even greater for women with HIV. Furthermore, standard risk equations ofen underestimate cardiovascular risk in people with HIV, notably women. This means that current risk assessment tools may not accurately identify individuals who would benefit from preventative measures.
[EXPAND: Include a table comparing cardiovascular risk factors (e.g., cholesterol levels, blood pressure) in HIV-positive vs. HIV-negative populations. Cite specific studies.]
What the New Guidelines Recommend
The updated guidelines address several key areas:
* Immune Activation and Inflammation: While the guidelines acknowledge the role of immune activation and inflammation in cardiovascular disease, they currently do not recommend switching or adding ART solely to reduce these factors, accept within the context of clinical trials. More research is needed to determine effective strategies for targeting inflammation.
* Cardiovascular Complications: The new chapter covers immune activation and inflammation, cardiovascular complications, statin therapy and weight gain.
* Statin Therapy: A significant update in 2024 is the advice for statin therapy for HIV-positive individuals aged 40-75 with low to moderate cardiovascular risk scores. This recommendation is based on the landmark REPRIEVE trial, which demonstrated a 35% reduction in the risk of heart attack, stroke, and other major cardiovascular events with daily statin use in this population.
* Low Risk: Statins are favored even for those with low risk scores,though the benefits are more modest.
* High Risk: Statins remain strongly recommended for individuals with high cardiovascular risk scores, regardless of HIV status.
* Under 40: there is currently insufficient evidence to make a recommendation for statin use in people under 40 with HIV.
* Other Considerations: The guidelines note that other vital cardiovascular disease manifestations and metabolic complications (such as insulin resistance, diabetes, metabolic syndrome, metabolic dysfunction-associated steatotic liver disease, heart failure, sudden cardiac death and bone disease) are not currently covered in detail. Management of these conditions remains similar for people with and without HIV, but these areas are subject to ongoing research.